Bariatric surgery and gastroesophageal reflux disease

Abstract

With the rapidly increasing prevalence of obesity globally, the practice of bariatric surgery is being adopted routinely to prevent the development of chronic conditions as well as some forms of cancers associated with obesity. Gastroesophageal reflux disease (GERD) is one of those chronic conditions. Furthermore, there is accumulating data that obesity is associated with complications related to longstanding GERD such as erosive esophagitis (EE), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC).Central obesity, rather than body mass index (BMI), appears to be more closely associated with these complications. It should be expected, therefore, that weight loss procedures should result in improvement in GERD symptoms and its associated complications. However, in reality the different bariatric surgical procedures have unpredictable effects on an established GERD and may even produce GERD symptoms for the very first time (de novo). In this review, we explore the literature studying the effects of bariatric surgical operations on GERD. Roux-en-Y gastric bypass appears to have the most beneficial effect on GERD. On the other hand, laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding (LAGB) are linked with long-term increased prevalence of GERD. We argue that GERD is an extremely important preoperative consideration for any patient undergoing bariatric surgery and therefore should be thoroughly investigated objectively (with 24-hour pH study and high-resolution manometry) to select the most suitable bariatric procedure for patients for their long-term success.

Rethinking gastroesophageal reflux disorder

“…113 This has driven the use of Roux-en-Y gastric bypass (RYGB) for patients with a BMI > 35 and GERD with favorable outcomes over fundoplication demonstrated in the literature. [114][115][116] RYGB has a different antireflux mechanism to fundoplication. The creation of a small proximal gastric pouch separates the majority of the acidproducing stomach from the distal esophagus and the creation of a Roux-en-Y reconstruction of the small bowel prevents the reflux of bile into the distal esophagus.…”

“…In addition to its association with reflux disease, obesity is also a strong risk factor for the failure of laparoscopic antireflux surgery with one meta‐analysis finding a 53% increased risk over nonobese patients 113 . This has driven the use of Roux‐en‐Y gastric bypass (RYGB) for patients with a BMI > 35 and GERD with favorable outcomes over fundoplication demonstrated in the literature 114–116 . RYGB has a different antireflux mechanism to fundoplication.…”

Simultaneous surgeries in bariatric surgery (literature review)

“…У пациентов с морбидным ожирением в 50-70% наблюдений присутствуют симптомы гастроэзофагеальной рефлюксной болезни (ГЭРБ), а в 20-52% имеется и параэзофагеальная грыжа [55,56]. Распространенности этих заболеваний способствует повышенный градиент брюшно-грудного давления, а снижение веса является одним из основных направлений консервативного лечения ГЭРБ.…”

Study on The Symptoms and Esophageal Motility Characteristics of Gastroesophageal Reflux Disease Patients with Obesity

“…Without treatment, 10% of people will be at risk for esophageal adenocarcinoma. 14,15 There are also contradictions and disputes in various research conclusions.…”

“…15)] and the O-NG group [0.00 (0.00,0.85)] (P<0.05); the EGJ separation distance of the NO-G group was significantly larger than that of the NO-NG group (P<0.05); there was no statistical difference in the EGJ separation distance between the O-NG group and NO-G group, so do the O-NG group and the NO-NG group either (P>0.05).…”