USE OF 24 H ESOPHAGEAL PH MONITORING TO DEMONSTRATE ALKALINE REFLUX AS A COMPLICATION OF GASTRIC BYPASS-SURGERY

A 35-year-old female who had previously undergone a gastric stapling p rocedure for morbid obesity presented with a persistent nocturnal coug h that was treated over a three-year period as a gastric acid reflux c omplication of the bypass surgery. A barium swallow demonstrated gastr oesophageal reflux, but the symptoms did not resolve after treatment w ith omeprazole and cisapride. Twenty-four house esophageal pH monitori ng subsequently found alkaline reflux in excess of 17% of the total ti me, with no acid reflux demonstrated. Surgical revision of the bypass leaving the hiatus alone corrected the reflux complication and the sym ptoms resolved without further treatment. The diagnostic capability of pH monitoring is illustrated in a patient with an unusual surgical co mplication.