Gastroesophageal Reflux Disease In Obese Patients Research Articles

GERD as a Complication of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Systematic Review and Meta-Analysis.

The incidence of obesity is increasing in developed societies, and surgical treatment is one treatment option. The most common surgical treatment for obesity is laparoscopic sleeve gastrectomy (LSG). Gastroesophageal reflux disease (GERD) is a complication of both obesity and the surgical treatment of obesity. In this study, the PubMed database was searched using the keywords "GERD" and "bariatric surgery", and 987 papers published between 1 July 2017 and 30 June 2022 were retrieved. Nine papers met the inclusion criteria and were included in the meta-analysis. The articles were analyzed for the de novo occurrence of GERD after the treatment of its symptoms, the occurrence of erosive esophagitis, and Barrett's esophagus. In addition, interesting conclusions are presented from the papers that did not meet the inclusion criteria but shed light on the pathophysiology of GERD in obese patients undergoing LSG. In conclusion, the authors draw attention to the need for endoscopic surveillance in patients undergoing LSG, even in the absence of clinical signs of GERD.

GASTRO-ESOPHAGEAL REFLUX DISEASE BEFORE AND AFTER BARIATRIC SURGERIES

Background: The relationship between obesity and gastro esophageal reflux disease (GERD) risk has been well established. Many authors suggest performing esophagogastroduodenoscopy (OGD) in all patients before bariatric procedures. On the other hand, many other investigators advocate a selective approach for asymptomatic patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered by most experts the procedure of choice for the management of GERD in obese patients; however, the effect of LSG on GERD is still unclear. Objective: To identify presences or absences of GERD in patients undergoing different types of bariatric surgery and the effect of this surgery on GERD status post operatively. Patients and Methods: This study included forty successive morbidly obese patients who present to Surgery Department of Al-Azhar University Hospitals seeking for bariatric surgery, during the period from January 2018 to April 2020. Seventeen (42.5%) of the patients were males, while twenty-three (57.5%) were females. Upper endoscopy was performed preoperatively in all cases. Full history, physical examination and special investigations were taking, Patients was classified into laparoscopic sleeve gastrostomy (LSG) group (14 cases), laparoscopic greater curvature gastric plication (LGCGP) group, (3 cases), LRYGB group, (19 cases), and laparoscopic mini gastric bypass (LMGB) group, (4 case). OGD was done preoperatively in all patient and yearly postoperatively for two successive year. Result: In LSG group (14 cases), post-operatively with follow up by OGD, there was five cases (35.7%) have GERD sings and the rest of cases, nine cases (64.3%) have normal esophageal mucosa. In LRYGB group, all patients have normal esophageal mucosa after operation. In LGCGP group, three cases, post-operatively with follow up by OGD, there was one case (33.3%) have GERD signs, and the rest of cases, two cases (66.7%) have normal esophageal mucosa. In LMGB group, two case 50% improved in the 2nd year, one (25%) improved from the 1st year, and one case (25%) has increased GERD symptoms, signs, and biliary reflux. Conclusion: OGD should be done before bariatric procedures routinely or selectively, Laparoscopic Roux-en-Y gastric bypass (LRYGB) was considered the procedure of choice for the management of GERD in obese patients, However LSG still unclear on obese patient with GERD.

Efficiency of Cruroplasty as a Treatment of Gastro-Esophageal Reflux Disease in Morbid Obese Patients with Hiatus Hernia during SleeveGastrectomy

Abstract Background The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG. Aim of the Work To analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). Patients and Methods This is a retrospective cohart study. We collected the data of Patients who underwent lap sleeve gastrectomy with cruroplsty in the same operation in the period between July 2018 and July 2019. Results Before surgery, symptomatic GERD was present in 14 patients (70%), and HH was diagnosed In 20 patients (100%), HH was diagnosed pre-operatively. The mean follow-up was 6 months. GERD remission occurred in 18 patients (90%). In the remaining 2 patients, antireflux medications were diminished, with complete control of symptoms. HH recurrences developed in 1 patient (10%). "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR. Conclusion SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively.

Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up.

Gastroesophageal reflux disease (GERD), including erosive esophagitis, is highly prevalent in the obese population. Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. The relationship between LSG and GERD has gained increasing attention. This retrospective study aimed to assess the effectiveness of combined LSG and modified Rossetti antireflux fundoplication for the treatment of GERD on morbidly obese patients after bariatric surgery. To assess the effectiveness, on morbid obese patients, of combined SG and Rossetti fundoplication for the treatment of GERD in obese patients. Public Hospital, Italy. From January 2015 to May 2018, 220 obese patients (167 female; 53 male) underwent LSG and modified Rossetti antireflux fundoplication procedure, performed by 4 different expert bariatric surgeons. Data have been collected in an Excel file and processed by XLStat to perform statistical analyses. We analyzed short-term complications and medium-term results with 24-month follow-up in terms of weight loss, remission of co-morbidities, and resolution of GERD. Mean BMI was 42.58 ± 5.93 kg/m2 (range, 31.70-63.16). Patients suffering from GERD before surgery were 137 of 220 (62.3%). No intraoperative complications or conversion were reported. Regular postoperative course was recorded in 90% of patients (198 of 220 patients). Gastric perforation has always occurred on the fundoplicated portion of the stomach. This perforation, which is different from the well-known post-LSG gastric fistula, may be because of incorrect gastric fundus manipulation. Rate of reoperation was 14 of 220 (6.4%). A good sense of repletion without episodes of vomiting, nausea, or dysphagia was reported in 95% of the analyzed patients. Of patients, 98.5% did not suffer from reflux symptoms and did not take proton pump inhibitors. A decrease in BMI and percent of total weight loss at follow-up were comparable with LSG. Endoscopic follow-up is still ongoing. Improvement in esophagitis was observed in 63 of 65 (96.92%) patients and all 4 patients shows improvement in Barrett's esophagus. LSG and modified Rossetti antireflux fundoplication procedure is a tolerated and feasible procedure in obese patients, with good postoperative weight loss results and improvement in GERD.

Relationship Between Bariatric Surgery and Gastroesophageal Reflux Disease: a Systematic Review and Meta-analysis.

The purpose of this study was to investigate the relationship between bariatric surgery (laparoscopic sleeve gastrectomy [LSG] and laparoscopic Roux-en-Y gastric bypass [LRYGB]) and gastroesophageal reflux disease (GERD). The number of obese patients with newly onset, worsened, or improved GERD after bariatric surgery in each article were extracted. In the pooled analysis, LSG was associated with a higher risk of GERD than LRYGB (odds ratio [OR] = 5.10, 95% confidence interval [CI] 3.60-7.23, p < 0.001). Compared with LSG, LRYGB had a better effect on GERD (OR = 0.19, 95% CI 0.12-0.30, p < 0.001). LRYGB was more effective for treating GERD in obese patients than LSG and the incidence of newly onset GERD after LRYGB was lower.

Esophageal pH and impedance reflux parameters in relation to body mass index, obesity-related hormones, and bariatric procedures.

Introduction Obese patients have a higher risk of gastroesophageal reflux disease (GERD), but obesity‑related hormonal changes associated with GERD and the effects of bariatric therapy on reflux are unclear. Objectives The aim of the study was to assess reflux parameters in relation to bariatric therapy and hormonal changes in obese patients. Patients and methods This prospective observational study with a 1‑year follow‑up included 53 obese patients undergoing bariatric therapies. Esophageal pH and impedance monitoring tests were performed and circulating hormone levels were analyzed. Results Esophageal acid exposure time (%AET) and the number of refluxes correlated positively with body mass index. There were several significant, although weak, correlations of pH and impedance parameters with ghrelin and omentin levels. Patients with abnormal %AET had lower ghrelin levels and those with abnormal reflux number had lower omentin levels than patients with normal parameters. Although we observed certain changes including increased %AET and bolus clearance time (BCT) after laparoscopic sleeve gastrectomy, a reduced BCT and number of refluxes after gastric band, and nonsignificant changes after intragastric balloon, the overall bariatric therapy did not significantly impact on the final GERD diagnosis. GERD before and after therapy was present in 42% of patients. De novo GERD developed in 17.8% of patients, while a similar percentage of patients with initial GERD had normal pH and impedance after therapy. Patients with de novo or persistent GERD had a similar percentage of weight loss as patients without GERD. Conclusions Bariatric therapy and percentage of weight loss do not significantly affect GERD. The observed hormonal changes alone do not fully explain the high prevalence of GERD in obese patients.

The Improvement of Gastroesophageal Reflux Disease and Barrett's after Bariatric Surgery.

Obesity and gastroesophageal reflux disease (GERD) are prevalent in Western populations. In obese patients, high-resolution manometry often shows altered gastroesophageal pressure gradients, promoting retrograde gastric content flow into the esophagus and esophagogastric junction disruption, leading to a hiatal hernia. Hernia recurrence is higher in the obese, and recurrence is seen regardless of the operative approach used. Bariatric surgery is the gold-standard treatment for GERD in obese patients, and symptom improvement varies depending on the specific bariatric procedure performed, Roux-en-Y (RYGB), laparoscopic adjustable gastric banding (LAGB), or sleeve gastrectomy (SG). Studies have shown these surgeries significantly improve GERD, but RYGB had the greatest effect. Limited data is available examining the progression or regression of Barrett's following bariatric surgery. We currently recommend RYGB for morbidly obese patients with Barrett's esophagus.

Medically refractory gastroesophageal reflux disease in the obese: what is the best surgical approach?

Obesity is a recognized risk factor for gastroesophageal reflux disease (GERD). Traditional antireflux surgery (fundoplication) may not be appropriate in the morbidly obese, especially when other effective alternatives exist (bariatric surgery). A 13-item survey was designed to elicit professional opinions regarding the treatment of medically refractory GERD in obese patients. Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) were randomly selected and emailed a link to an online survey. A total of 550 surgeons were contacted via email, and 92 (17 %) completed the survey. Of the respondents, 88 % perform laparoscopic antireflux surgery, 63 % perform bariatric surgery, and 59 % perform both. Overall, 77 % completed a minimally invasive surgery fellowship. In response to the question "Would you perform a laparoscopic fundoplication in a patient with medically refractory GERD and a BMI of 'X'?" surgeons were less likely to offer fundoplication at a higher body mass index (BMI). The majority of respondents felt that laparoscopic Roux-en-Y gastric bypass was the best option (91 %), followed by laparoscopic sleeve gastrectomy (6 %). Many had a morbidly obese patient with a primary surgical indication of GERD denied a bariatric procedure by their insurance company (57 %), and 35 % of those surgeons chose to do nothing rather than subject the patient to a fundoplication. Respondents uniformly felt that bariatric surgery should be recognized as a standard surgical option for treating GERD in the obese (96 %). When surgical treatment of GERD is indicated in an obese patient, bariatric surgery is the optimal approach, in the opinion of surgeons responding to our survey. Unfortunately, third-party payers often decline to provide benefits for a bariatric procedure for this indication. Additional data is necessary to confirm our belief that the opinions elicited through this survey are consistent with the standard of care as defined by the medical community.

The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients

BackgroundObesity is an independent risk factor for gastroesophageal reflux disease (GERD), which is often associated with the presence of a hiatal hernia (HH). Despite increasing popularity of laparoscopic sleeve gastrectomy (LSG) in bariatric surgery, its effect on GERD is still unclear. The objective of this study was to evaluate the effect of LSG with or without hiatal hernia repair (HHR) on GERD in obese patients. MethodsSeventy-eight patients with HH underwent LSG with concomitant HHR (LSG+HHR group). Their data were compared with that of 102 patients without HH, who underwent only LSG (LSG-group). All patients underwent a standardized questionnaire, a double-contrast barium swallow, and an upper-gastrointestinal endoscopy before the surgical procedure and at least 6 months later. ResultsAt baseline, the prevalence of GERD symptoms and their frequency-intensity scores did not differ between groups. At follow up, there was a significant decrease in the prevalence of typical GERD symptoms only in the LSG-group (P = .003). LSG+HHR patients showed a significantly higher heartburn frequency-intensity score compared with LSG patients (P = .009). ConclusionThis finding confirms that LSG has a beneficial effect on relieving GERD symptoms, although the underlying mechanisms are still unclear; conversely, the procedure of HHR did not produce any improvement in GERD symptoms.

Amelioration of Gastroesophageal Reflux Symptoms following Roux-en-Y Gastric Bypass for Clinically Significant Obesity

Symptoms of gastroesophageal reflux disease (GERD) are frequent in patients with clinically significant obesity and are reported to improve after Roux-en-Y gastric bypass (RYGB). The purpose of this study is to determine timing and duration of improvement of GERD symptoms in patients undergoing RYGB. Prospectively collected data from patients who underwent RYGB from January 1998 to August 2004 were analyzed. Patients answered a standardized questionnaire pre- and postoperatively inquiring about frequency of GERD symptoms (none, one episode/ week, one episode/day, more than one episode/day) and medication use. Of 606 patients undergoing RYGB, 239 patients (39%) reported GERD symptoms preoperatively (mean age 43 +/- 1 years; body mass index 51 +/- 1 kg/m2). Of these, 89 per cent of patients reported improved at 3 months post-op and 94 per cent of patients 9 months post-op (P < 0.001). Medication usage decreased from 30 per cent to 3 per cent by 3 months and 5 per cent beyond 9 months (P < 0.001). Percentage of excess weight loss was 18 +/- 1 per cent and 75 +/- 2 per cent at 3 and 9 months, respectively. Symptoms of GERD significantly improve and use of antireflux medications is reduced after RYGB independent of weight loss. RYGB may be the treatment of choice for GERD in obese patients.

Surgical Management of Gastroesophageal Reflux Disease in Obese Patients

Obesity or morbid obesity is common among patients who are seeking surgery for refractory gastroesophageal reflux disease (GERD). Several surgical options for treating GERD in obese patients are available. Fundoplications may be effective, at least in the short-term, but have no effect on weight loss and comorbidity reduction. Silicone-adjustable gastric banding and Roux-en-Y gastric bypass have different antireflux mechanisms, but also have proven efficacy against GERD and result in significant weight loss and comorbidity reduction. Vertical banded gastroplasty is not an effective antireflux procedure, and it may induce GERD in some patients. The malabsorbtion operations have no proven efficacy against GERD. Patients with severe obesity who are seeking surgical treatment for GERD should be considered for silicone adjustable gastric banding or Roux-en-Y gastric bypass because of the added benefit of weight loss and consequent comorbidity reduction.