Application of High-Resolution Impedance Manometry for Evaluation of Gastroesophageal Reflux Disease in Patients with Obesity Based on the Updated Lyon Consensus 2.0 and Chicago Classification v4.0

The relationship between the symptomatology and mechanisms of gastroesophageal reflux disease (GERD) in patients with obesity remains unclear.

To investigate the clinical manifestations and pathophysiology of GERD in patients with obesity.

The prospective study enrolled 62 patients with obesity undergoing evaluation for bariatric surgery. All patients completed standardized symptom questionnaires, esophagogastroduodenoscopy, and high-resolution impedance manometry (HRIM). Esophageal motility was assessed according to the updated Chicago Classification v4.0, and gastroesophageal reflux disease (GERD) was diagnosed based on the Lyon Consensus 2.0. Impedance reflux (IR) was detected at various positions during HRIM.

A total of 43.5% of patients were diagnosed with proven GERD based on a study-specific adaptation of the Lyon Consensus 2.0 in the absence of ambulatory pH or pH-impedance monitoring, while 25.9% reported GERD-like symptoms. Additionally, 8.1% of patients had an esophageal motility disorder. Abnormal esophagogastric junction (EGJ) structures were identified, including hiatal hernia in 33.9% of patients, compromised gastroesophageal flap valve in 61.3%, and abnormal EGJ type in 48.4%. A higher prevalence of erosive esophagitis and decreased esophageal body contractility was observed in patients with supine IR, whereas those with upright IR exhibited a higher prevalence of hiatal hernia or abnormal EGJ. Both supine and upright IR were associated with more severe reflux symptoms. Supine IR was independently associated with proven GERD, with an adjusted odds ratio of 3.17 (95% CI: 1.07–9.419).

Our study demonstrated a high proportion of disrupted EGJ barriers and proven GERD, but less remarkable symptom burden in patients with obesity. HRIM-detected IR may provide adjunctive physiological information, but requires validation against ambulatory reflux monitoring before being used in clinical decision-making.