Gastric bypass surgery in the treatment of gastro‐oesophageal reflux symptoms

Abstract

Background: Gastric bypass is considered an effective treatment of co-existing gastro-oesophageal reflux (GERD) and obesity. Previous studies have had small sample sizes, short follow-up or substantial loss to follow-up. Aim:To assess the long-term risk of remaining/recurring reflux symptoms after gastric bypass. Methods:This was a nationwide cohort study of all adults with preoperative reflux who underwent gastric bypass in Sweden between 2006 and 2015, with complete follow-up through 2016. The outcome was remaining/recurring reflux symptoms, defined as use of proton pump inhibitors or histamine-2 receptor antagonists for >6 months after surgery. Cumulative incidence and risk factors of reflux were assessed with multivariable Poisson regression.Results: Among 2454 participants (81.7% female; mean age: 46.1 years, SD: 9.8 years), who were followed for median 4.6 years (interquartile range: 3.1-6.3 years), reflux recurred in 48.8% (95% confidence interval [95% CI], 46.8-51.0) of participants within 2 years of gastric bypass and remained stable up to 10 years after surgery (yearly change in incidence rate ratio [IRR] of 1.00; 95% CI, 0.99-1.02). Risk factors for recurring reflux were high preoperative dose of anti-reflux medication (IRR 1.77; 95% CI, 1.60-1.96 compared with low dose), older age (IRR 1.12; 95% CI 1.02-1.24 comparing age >50 with <40 years), female sex (IRR 1.28; 95% CI, 1.16-1.42) and comorbidity (IRR 1.26; 95% CI, 1.14-1.39 comparing Charlson Comorbidity Index ≥2 with 0). Conclusions:Reflux symptoms decrease rapidly after gastric bypass, but around half of operated patients require continuous anti-reflux medication. The treatment efficacy of gastric bypass on reflux symptoms might have been overestimated.

Oral Health–Related Quality of Life After Gastric Bypass Surgery

“…However, some individuals may still perceive problems and the findings are in line with those in an early paper by Heling et al although their study included several bariatric surgical techniques [40]. A recent study showed that perhaps the treatment efficacy of GBP on reflux symptoms is overestimated, as many patients still require anti-reflux medication [41]. General causes for dental erosion can be excessive consumption of soft drinks with a low pH level [42].…”

Roux-en-Y Gastric Bypass as a Treatment for Barrett’s Esophagus after Sleeve Gastrectomy

“…One of the present study's additional strengths is certainly that it is not only based on information gained from gastroscopies but also from 24 h pH-metry, which revealed a decrease in reflux activity and lower DeMeester score after the conversion to RYGB. However, these results may not last: Holmberg et al found that reflux may remain or recur after RYGB as 50% of their patients are suffering from reflux 10 years after the procedure and maintain antireflux medication [13].…”

“…A common and efficient way of treating reflux after SG is converting patients to Roux-en-Y gastric bypass (RYGB) [11,12]. However, reflux symptoms may prevail or recur even after RYGB as Holmberg et al were able to show in a recent study [13]. While a few studies based on a small number of obese patients have shown that RYGB may cause BE to disappear by curing patients' reflux [14,15], the question whether the same might go for RYGB performed after SG has not been answered in literature, yet.…”

Magnetic Sphincter Augmentation After Gastric Surgery

“…14 A population study in Sweden concluded that about 50% of patients undergoing RYGB require continuous PPI therapy and that the efficacy of this procedure in controlling GERD may have been overestimated. 15 MSA could be an effective therapeutic modality to control refractory GERD symptoms in these patients. The aim of this study was to perform a systematic review of the literature on the management of persistent or de novo reflux after gastric/bariatric surgery with MSA and to report our personal experience.…”