Reflux following bariatric surgery

Abstract

Bariatric surgery is the most effective treatment for morbidly obese patients. Studies investigating the relationship between bariatric surgery and gastroesophageal reflux disease (GERD) are discordant. Depending on the type of intervention, pre-existing GERD can improve, worsen, or develop “de novo” in previously unaffected patients. Therefore, a review of the literature is performed to evaluate the effects of different bariatric surgical procedures on GERD. Currently, the bariatric surgical procedures more frequently performed are laparoscopic sleeve gastrectomy (LSG) and gastric bypass. The majority of studies examining the relationship between GERD and bariatric surgery are low quality, small, and non-randomized. Furthermore, GERD has been investigated through clinical symptoms scales or questionnaires, which often do not correlate with objective endoscopic or functional findings. Therefore, the interpretation of the results of these studies is challenging. Roux-en-Y gastric bypass is considered the preferred surgical operation for bariatric patients with GERD. Despite contradictory results reported among the studies, GERD seems to be a major issue after LSG. Preliminary results on mini-gastric bypass/one anastomosis gastric bypass seem to indicate that biliary reflux might be overrated, but more long-term results are mandatory before drawing conclusions. Further studies are needed to clarify the role of extensive preoperative examinations prior to bariatric surgery, even in asymptomatic patients, and provide clear guidance regarding the indications for the bariatric surgery technique of choice according to the patient’s characteristics.