Gastroesophageal Reflux in a Cohort of Morbidly Obese Patients Before and After Sleeve Gastrectomy

Abstract

Introduction: Laparoscopic sleeve gastrectomy (LSG) offers excellent sustainable weight loss for morbidly obese patients. Previous studies have demonstrated an increase in gastroesophageal reflux (GER) following LSG. The aim of this study was to compare acid reflux parameters in a cohort of obese patients before and after surgery. Methods: We prospectively enrolled adult obese patients greater than 18 years old undergoing preoperative evaluation for LSG. Patients underwent PPIs pre-operative 24 hour combined ambulatory pH and impedance testing off of PPI. Studies were repeated at least 6 months after LSG. Reflux data collected included Johnson-DeMeester (JD) score, to include percent total time pH<4, percent supine time pH<4, percent upright pH <4, number of reflux episodes <5 minutes, longest reflux episode, and impedance testing results. Results: We enrolled 18 consecutive adult patients presenting for preoperative evaluation for LSG with a mean age of 51.5 (SD); 7 were white (78%), and 2 were male (22%). Sixteen patients successfully underwent LSG, of which 9 patients completed their post-operative testing. After LSG, there was a statistical increase in mean acid reflux episodes from 24.36 to 51.57 (p=0.03) and mean distal esophageal impedance episodes from 47.67 to 69.78 (p=0.04), but no change in proximal impedance (p=0.16). Although there was an almost 2-fold increase in mean JD score from 16.68 to 31.23 (p=0.09), this was not statistically significant. Likewise, there was no statistically significant change in total percent time (p=0.23), percent upright reflux (p=0.44), percent supine reflux (p=0.08), number of reflux episodes >5 minutes (p=0.21), or longest reflux episode (p=0.37). Conclusion: In this small ongoing study, LSG significantly increased the number of acid and impedance reflux episodes. A trend towards an increase in JD score was observed.