Gastrointestinal Disorders

Metabolic and bariatric surgery (MBS) represents the most effective therapeutic approach for achieving substantial and sustained weight loss and improving obesity-related comorbidities. However, the role of routine preoperative esophagogastroduodenoscopy (EGD) remains controversial, and current recommendations vary among international professional societies. Obesity is associated with a high prevalence of upper gastrointestinal disorders, including gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, gastritis, Helicobacter pylori infection, gastric intestinal metaplasia, and peptic ulcer disease. Importantly, clinically relevant endoscopic abnormalities may occur in asymptomatic patients, limiting the reliability of symptom-based strategies for selecting candidates for EGD. Preoperative endoscopic findings may require medical treatment, additional diagnostic investigations, endoscopic surveillance, or modification of the planned bariatric procedure. This is particularly relevant when considering sleeve gastrectomy in patients with significant reflux-related disease or Barrett’s esophagus, as well as gastric bypass procedures that may limit subsequent endoscopic access to the excluded stomach. This narrative review summarizes current evidence regarding the clinical value of preoperative EGD in MBS, with particular emphasis on relevant gastroesophageal and gastric findings, standardized endoscopic assessment, their implications for surgical decision-making, and current international recommendations.

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder associated with genetic susceptibility conferred primarily by HLA-DQ2 and HLA-DQ8. Although HLA genotyping cannot confirm CD because these profiles are common in individuals without the disease, it has a complementary role in the diagnostic evaluation, particularly when compatible HLA profiles are absent. Contemporary data on the distribution of CD-associated HLA profiles in Central America remain limited. This study aimed to characterize the distribution of HLA-DQ2.2, HLA-DQ2.5, and HLA-DQ8 profiles among patients referred for CD-related genetic testing in Costa Rica and to evaluate their distribution according to biological sex and age. Methods: We retrospectively evaluated HLA-DQ2/DQ8 genotyping records from patients tested for suspected CD at Hospital Clínica Bíblica, Costa Rica, between January 2018 and August 2024. After patient-level review of 361 complete determinations from 292 unique patients, four patients with unresolved discordant repeated results were excluded, yielding a final analytical cohort of 288 patients. HLA profiles were summarized descriptively, and associations with sex and age were evaluated using Fisher’s exact test, the Mann–Whitney U test, and Pearson’s chi-square test, with Holm adjustment for multiple comparisons involving individual HLA profiles. Results: Among 288 patients, 207 (71.9%) were female, and the median age was 33 years. HLA-DQ8 was the most frequently detected CD-associated profile (31.9%; 95% CI 26.8–37.5%), whereas HLA-DQ2.2 and HLA-DQ2.5 were each detected in 19.4% (95% CI 15.3–24.4%). Overall, 59.7% of patients carried at least one of these three profiles, while 112 (38.9%; 95% CI 33.4–44.6%) had negative results for all four evaluated assay components. No statistically significant associations were identified between individual HLA profiles and biological sex after adjustment for multiple comparisons. Age did not differ according to overall HLA-profile status (p = 0.874), and HLA-profile distribution did not differ significantly across age groups (p = 0.677). Conclusions: HLA-DQ8 was the most frequently detected CD-associated HLA profile in this clinically referred Costa Rican cohort, while DQ2.2 and DQ2.5 occurred at lower and similar frequencies. No significant associations with biological sex or age were identified. These findings provide contemporary data on HLA-DQ2/DQ8 distribution in a Costa Rican clinical setting but should not be interpreted as estimates of population HLA prevalence or CD prevalence. Studies integrating HLA genotyping with clinical, serological, histological, and diagnostic outcome data are needed to establish the clinical significance of these distributions.

Background: Bicarbonate mineral waters have been reported to modulate biliary dynamics. Prior symptom-based data with Aqua 3 suggested digestive benefits, but objective confirmation is still lacking. Aims: We sought to evaluate the effect of Aqua 3 on gallbladder motility in fasting healthy adults, compared with an oligomineral water. Methods: In this randomized, crossover study, twenty healthy volunteers underwent two ultrasound sessions after an overnight fast and the ingestion of 500 mL of either Aqua 3 (bicarbonate-rich mineral water) or oligomineral water. Gallbladder volume was measured at baseline and after 10, 20, 30, and 60 min. Primary endpoint was the maximum observed ejection fraction. Results: Bicarbonate-rich mineral water induced a rapid increase in ejection fraction: peaking at 10 min, persisting at 20 min and attenuating by 30 min. At 60 min, gallbladder refilling exceeded baseline. Oligomineral water produced only modest early emptying at 10 min, no significant change at 20 min, and progressive refilling thereafter. Throughout the observation period, ejection fraction was significantly higher after bicarbonate than oligomineral water. Maximum observed ejection fraction was significantly greater with bicarbonate than oligomineral water, occurring most frequently at 10 min for both waters. Conclusions: Because the study compared Aqua 3 with one selected oligomineral water and the two waters differed in several chemical–physical characteristics, including bicarbonate, free CO₂, calcium, magnesium, and sodium, the observed response cannot be attributed exclusively to the bicarbonate content and should be interpreted as an effect of Aqua 3. This rapid and sustained effect is potentially useful in the clinical setting to improve early phases of postprandial digestion and providing a mechanistic rationale for the previously reported digestive benefits of bicarbonate-rich mineral water. These results describe an acute physiological effect and require confirmation in larger studies, including postprandial settings and clinical populations, before therapeutic implications can be drawn.