Gastroesophageal reflux disease and bariatric surgery: many questions, few answers

Abstract

Gastroesophageal reflux disease (GERD) is estimated to be present in approximately 40% of morbidly obese patients; thus testing to define presence and severity of GERD should be done in the symptomatic prospective bariatric surgical patient as to be included in the multifaceted decision making process to choose the better bariatric surgical technique [ [1] Chiu S. Birch D.W. Shi X. Sharma A.M. Karmali S. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011; 7: 510-515 Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar ]. The presence of GERD is viewed by some as a relative contraindication to the use of laparoscopic sleeve gastrectomy (LSG) [ [2] DuPree C.E. Blair K. Steele S.R. Martin M.J. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014; 149: 328-334 Crossref PubMed Scopus (194) Google Scholar ], as LSG has a significantly lower rate of improving or resolving GERD than laparoscopic gastric bypass [ 2 DuPree C.E. Blair K. Steele S.R. Martin M.J. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014; 149: 328-334 Crossref PubMed Scopus (194) Google Scholar , 3 Peterli R. Borbely Y. Kern B. Gass M. Peters T. Thurnheer M. et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg. 2013; 258 (discussion 5): 690-694 Crossref PubMed Scopus (258) Google Scholar ] and LSG is associated with de novo troublesome GERD symptoms in about 20% of patients [ 4 Himpens J. Dobbeleir J. Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010; 252: 319-324 Crossref PubMed Scopus (552) Google Scholar , 5 Del Genio G. Tolone S. Limongelli P. Brusciano L. D׳Alessandro A. Docimo G. et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014; 24: 71-77 Crossref PubMed Scopus (108) Google Scholar ]. In addition, the presence of Barrett’s esophagus is considered a formal contraindication to LSG [ [6] Rosenthal R.J. International Sleeve Gastrectomy Expert P. Diaz A.A. Arvidsson D. Baker R.S. Basso N. et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012; 8: 8-19 Abstract Full Text Full Text PDF PubMed Scopus (671) Google Scholar ]. Frequency of abnormal esophageal acid exposure in patients eligible for bariatric surgerySurgery for Obesity and Related DiseasesVol. 10Issue 6PreviewObesity and gastroesophageal reflux disease (GERD) are both high-prevalence diseases in developed nations. Obesity has been identified as an important risk factor in the development of GERD. The objective of this study was to determine the frequency of abnormal esophageal acid exposure in patients candidate for bariatric surgery and its relationship with any clinical and endoscopic findings before surgery. Full-Text PDF