Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery.

BACKGROUND: Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN: An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS: Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS: An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.

Ruminal Fiber Degradation Kinetics within and among Warm-Season Annual Grasses as Affected by the Brown Midrib Mutation.

The objective of this study was to compare the nutritional composition and the neutral detergent fiber (NDF) degradation kinetics of brown midrib (BMR) and non-BMR genotypes within and across warm-season annual grasses. Four commercial varieties (two non-BMR and two BMR) of corn, sorghum, and pearl millet were planted in plots. Forage samples were incubated in the rumen of three rumen-cannulated cows for 0, 3, 6, 12, 24, 48, 96, and 240 h. On an NDF basis, all forage types showed lower acid detergent lignin (ADL) concentrations for BMR genotypes, but the magnitude of the difference differed among forage types. The concentration of undegraded NDF (uNDF; NDF basis) differed among forage types and between genotypes. Corn had the least, pearl millet had the intermediate, and sorghum had the greatest concentration of uNDF. Non-BMR genotypes had greater concentrations of uNDF than BMR genotypes. No interaction existed between forage type and genotype for the concentration of uNDF. In conclusion, although BMR forages may show lower ADL concentrations in the cell wall and greater NDF degradability than non-BMR forages of the same forage type, BMR forages do not always have the least ADL concentration or the greatest NDF degradability when comparing different forage types.