Background

Obesity is a known risk factor for gastro-esophageal reflux disease (GERD). A complication of GERD is development of intestinal metaplasia, Barrett’s esophagus and esophageal adenocarcinoma. The aim of the study is to evaluate the prevalence of cardiac intestinal metaplasia (CIM) in the pre-operative bariatric surgery population.

Methods

A retrospective review was performed of all patients who underwent bariatric surgery from 2019-2022. We included patients who underwent primary bariatric surgery and had pre-operative gastro-esophageal junction biopsies. Our primary endpoint was prevalence of CIM on pre-operative biopsy. Secondary endpoints included reported GERD symptoms, antacid use, and endoscopic findings including esophagitis and hiatal hernia.

Results

We included 341 patients; 296 female, mean age 45, mean BMI 44.2. Twenty-six patients (7.6%) were noted to have CIM pre-operatively. Typical reflux symptoms were reported in 92.3% of CIM patients and 87.8% without(p=0.496). Seven (26.9%) of patients with CIM reported antacid use compared to 38.7% without CIM(p = 0.236). Twenty-four patients were found to have Helicobacter pylori, one with concurrent CIM(p=0.505). Endoscopic findings included hiatal hernia in 30.7% with CIM and 29.3% without(p=0.874). One patient in each group had LA-Grade C/D esophagitis.

Conclusions

At pre-operative baseline, our bariatric population has a CIM prevalence of 7.6%. There were no significant differences in age, BMI, sex, reflux symptoms, hiatal hernia, or antacid use between patients with or without pre-operative CIM. In the absence of markers to screen for CIM, pre-operative endoscopy may be considered in patients seeking to undergo bariatric surgery to establish a histologic baseline.