Prevalence and Predictors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy

Althuwaini, Saad; Bamehriz, Fahad; Aldohayan, Abdullah; Alshammari, Waleed; Alhaidar, Saleh; Alotaibi, Mazen; Alanazi, Abdullah; Alsahabi, Hossam; Almadi, Majid A

doi:10.1007/s11695-017-2971-4

Cited by 61 publications

(46 citation statements)

References 13 publications

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“…Our work which is currently under review showed 88% of reported GERD symptoms happened only post-prandial which suggest that the reflux symptoms after LSG may be related to nonacid volume reflux instead of acid reflux. This is consistent with Althuwaini et al which concluded 35.7% of regurgitation was nonacid food regurgitation [ 25 ]. Also there might be some unmeasured confounders, for example, smoking and alcohol consumption with GERD-Q or GERD-HRQL.…”

Section: Discussionsupporting

confidence: 92%

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

et al. 2020

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Background Laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric procedure in many countries. However, there is one shortcoming of LSG in the long-term follow-up, and this is the onset of gastro-esophageal reflux disease (GERD) and erosive esophagitis (EE). Conversion to Roux-en-Y gastric bypass (RYGB) is considered an option in patients unresponsive to medical therapy. Currently, there is no evidence of EE improvement or resolution after conversion surgery. In this study, we objectively evaluate the effectiveness of RYGB in management of EE with upper endoscopy (EGD) to identify the significant variables in patients with GERD symptoms post LSG refractory to medical therapy and require conversion surgery. Methods Over a period of 11 years (2008–2019) at Singapore General Hospital, we retrospectively reviewed a prospectively collected database of a cohort of patients whom had conversion surgery to RYGB for refractory GERD and EE after LSG. Patient’s endoscopic findings and demographic and anthropometric data were analyzed. Results We identified a total of 14 patients who underwent LSG to RYGB conversions for endoscopic proven erosive esophagitis in our unit during the study period. Eight patients (57.1%) had concurrent hiatal hernia repaired. Nine (64.3%) patients were females. The median age of patients in this cohort was 44 (range 30–61) years. Mean weight and BMI were 87.7 kg (± 19.2) and 32.8 (± 3.09) kg/m2, respectively, on the day of conversion surgery. The median time between LSG and revision to RYGB was 36 (range 6–68) months. Seven patients (50%) had complete resolution of GERD symptoms after conversion, and 6 patients (42.9%) had partial resolution. Six out of 7 patients had complete resolution of EE. There were 4 anastomotic strictures (28.6%). Older patients, Indian ethnicity, present of hiatal hernia and lower weight loss after initial LSG were more likely to undergo conversion surgery. Conclusion Conversion to RYGB after LSG is clinically relevant and may be a feasible solution if patients have ongoing GERD refractory to medical therapy. Ninety-three percent of our patients achieved complete resolution of their GERD symptoms and significant improvement of erosive esophagitis with significant weight loss after conversion. This study has important implications as LSG is increasingly being performed and a proportion of these will need revision surgery for various reasons, particularly GERD which is extremely prevalent.

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Section: Discussionsupporting

confidence: 92%

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

et al. 2020

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“…Dysgeusia also can be a persistent taste that is actually tasted, such as that caused by reflux. Gastroesophageal reflux, a side effect of morbid obesity as well as bariatric surgery [73], especially the sleeve gastrectomy [74], could contribute to a perception that things didn’t taste right or dysgeusia. The present study also was consistent with a previous report [45] that showed that post-bariatric surgery patients, especially if successful in weight loss, reported that they were better able to detect basic taste qualities.…”

Section: Discussionmentioning

confidence: 99%

Associations between Weight Loss, Food Likes, Dietary Behaviors, and Chemosensory Function in Bariatric Surgery: A Case-Control Analysis in Women

et al. 2019

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We tested the hypothesis that successful weight loss post-bariatric surgery would be associated with healthier chemosensory function, food likes, and dietary behaviors than either unsuccessful weight loss or pre-surgery morbid obesity. In a case-control design, pre-surgical women with morbid obesity (n = 49) were compared with those 1-year post-surgery (24 Roux-en-Y Bypass, 24 Sleeve Gastrectomy) and defined by excess or percent weight loss as successful/unsuccessful. For self-reported smell/taste perception, more post-surgery than pre-surgery reported improved/distorted perception, especially if weight loss successful. Measured taste function (perceived quinine and NaCl intensity) was lower among weight loss unsuccessful versus pre-surgery patients, yet a genetic variation in taste probe (propylthiouracil bitterness) matched expected frequencies without significant pre/post-surgery difference. Regarding survey-reported liking, higher diet quality was seen in the weight loss successful (independent of surgery type) versus pre-surgical patients, with differences driven by lower sweet and refined carbohydrate liking. The post versus pre-surgical patients had greater restraint but less hunger and disinhibition. Patients reporting both higher diet quality and lower hunger showed greater % weight loss, independent of surgery type. Thus, successful weight loss 1-year post-bariatric surgery was associated with improved or distorted chemosensation and patterns of liking associated with healthier diets, especially if coupled with less hunger.

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“…Prevalence rates reported by Althuwaini et al [23] , Boza et al [31] were 47.0% and 26.7% respectively. The possible explanation for this wide variance in prevalence could be attributed to different definitions of GERD; diagnostic methods used for confirmation of post LSG GERD and different inclusion criteria.…”

Section: Disucssionmentioning

confidence: 80%

“…This incidence lies with reported incidence in previous literature. Althuwaini et al [23] reported that although the majority of the patients did not develop new-onset symptoms or even had improved symptoms of GERD after LSG, there remained a significant proportion that developed new-onset symptoms or had worsening of symptoms of GERD after SG [ranging from as high as 35.7% for symptoms of regurgitation to as low as 16.0% for heartburn causing sleep disruption]. They concluded that some regurgitation was non-acid food regurgitation and hypothesized that regurgitation of gastric contents could have a major role in patient symptoms and might not be assessed completely by the questionnaire.…”

Section: Disucssionmentioning

confidence: 99%

Incidence of Esophageal Reflux after Laparoscopic Sleeve Gastrectomy for Morbid Obesity

Orouk¹,

Sayyouh

Salem

2020

International Journal of Medical Arts

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Background: Obesity is considered as an epidemic globally, which associated with gastroesophageal reflux disease [GERD]. Bariatrics surgery tends to reduce GERD manifestations. However, some reports noticed development of GERD after bariatric surgery; the problem which not addressed well in our community. Aim of the work: To estimate incidence of postoperative GERD after laparoscopic sleeve gastrectomy [SG] in patients with no history of GERD symptoms prior to surgery. Patients and Methods: Fifty morbidly obese patients who were scheduled for laparoscopic SG with no history of preoperative symptoms suggesting GERD and normal upper gastrointestinal endoscopy were included. All were assessed clinically and radiologically and followed-up for clinical or endoscopic GERD manifestations. Results: Females were predominant [76.0%]. Weight, body mass index and waist/hip ratio were significantly reduced after SG. Postoperative complications were leak [2.0%], wound infection [2.0%], bleeding [2.0%], stricture [4.0%] with overall rate of 8.0%. Incidence of GERD was 22.0% [11 patients; 4 grade A, 5 grade B and 2 grade C]. There was significant increase of Waist/hip ratio [both pre-and postoperatively] in patients who developed GERD when compared to those who did not develop GERD. In addition, there was significant increase of sleep related problems and stricture in patients who developed GERD when compared to those did not develop GERD [63.6%, 18.2% vs 17.9%, 0.0% respectively]. Conclusion: The incidence of GERD after SG was 22.0%. It was of mild or moderate nature, which denotes safety of SG. The procedure is also associated with marked weight reduction.

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Prevalence and Predictors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy

Abstract: Symptoms of heartburn and regurgitation are common after LSG; however, none of the variables preoperatively could strongly predict patients who would develop new onset or experience worsening of symptoms postoperatively.

Cited by 61 publications

References 13 publications

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Resolution of Erosive Esophagitis After Conversion from Vertical Sleeve Gastrectomy to Roux-en-Y Gastric Bypass

Associations between Weight Loss, Food Likes, Dietary Behaviors, and Chemosensory Function in Bariatric Surgery: A Case-Control Analysis in Women

Incidence of Esophageal Reflux after Laparoscopic Sleeve Gastrectomy for Morbid Obesity

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