This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Obesity has been considered to be a risk factor for gastroesophageal reflux disease (GERD). Several studies have shown that while there are obese patients with GERD, the incidence of obese patients with symptomatic GERD was no greater than in a population of normal-weight control patients. In addition, reduced lower esophageal sphincter pressure (LESP) was not more common in the obese than in the controls. Finally, there is controversy about whether weight loss improves symptoms in patients with GERD who are overweight. Patients with morbid obesity who undergo gastric restrictive weight loss procedures are successful in losing weight. Two restrictive procedures in use are the vertical band gastroplasty (VBG) and the adjustable laparoscopic band (Lap-Band). GERD and esophageal motility disturbances have been reported post-operatively in these patients. It is also known that obesity (BMI >35) is a risk factor for obstructive sleep apnea (OSA), more significantly in males. The factors involved in this association are still under investigation. Body fat distribution, hormonal differences and, recently, leptin levels have been suggested as possible etiologies of obesity. Leptin deficiency has been suggested as playing a role in other related respiratory disorders, such as obesity hypoventilation syndrome. There have also been several studies assessing the association of GERD and sleep disturbances. Recumbent posture has been considered a factor in GERD and 'reactive' esophageal clearance mechanisms are hindered by the recumbent posture and are inoperative during sleep, rapid eye movement sleep. In this proposal, the investigators aim to study the impact of weight loss after bariatric surgery on esophageal function and sleep. Primary goals are as follows: 1) test the hypothesis that obese patients will have a change from baseline in esophageal motility measured by manometry; 2) examine the change of 24-hour pH study from baseline; 3) examine the change of GERD symptoms score from baseline. Secondary goals are as follows: 1) examine if there are changes in gastrin, pepsinogen, leptin, and ghrelin six months and twelve months after bariatric surgery compared with patients' own baseline preoperatively; 2) examine the change of Helicobacter pylori status in obese patients with and without GERD symptoms; 3) examine nocturnal reflux and sleep disturbances in obese patients pre and post Lap-Band surgery.
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