Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass

Frezza, Eldo E.; Ikramuddin, Sayeed; Gourash, William; Rakitt, Tina; Kingston, Adean A.; Luketich, James D.; Schauer, Philip R.

doi:10.1007/s00464-001-8313-5

Cited by 276 publications

(154 citation statements)

References 29 publications

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“…For the morbidly obese patient who wants to lose weight and who has significant reflux symptoms but has failed weight loss programs, a Roux-en-Y gastric bypass may be the procedure of choice, as laparoscopic fundoplication will not address the issue of weight reduction. This operation provides excellent long-term relief of GORD 3,[16][17][18] and has the added benefit of long-term weight loss and the associated health benefits. LARS has been found to be as equally effective as a gastric bypass in the morbidly obese in relieving reflux symptoms, 20 and should still be offered to patients who do not desire bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Booth

Stratford

et al. 2007

annals

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INTRODUCTION Obesity has long been regarded as a risk factor for the development of gastro-oesophageal reflux disease (GORD). It has been claimed that surgical efficacy of laparoscopic anti-reflux operations is decreased in obese patients. The aim of this study was to assess whether laparoscopic anti-reflux surgery is effective in obese patients with GORD compared to non-obese patients. PATIENT AND METHODS A total of 366 patients (mean age 44 years; range, 12–86 years) underwent laparoscopic anti-reflux surgery between 1997–2003. Of these, 74 patients were considered obese; 58 patients had a body mass index (BMI) of 30–34 kg/m2 and 16 were classified as morbidly obese with a BMI ≥ 35 kg/m2. Pre-operative symptomatic scoring, indications for surgery, pH studies, operative times and complications were compared between obese and non-obese patients. Symptomatic outcome and Visick score between the two groups were assessed at 6 weeks, 6 months and 1 year following surgery. RESULTS Failure of medical treatment was the main reason for surgery in all groups. Operative time was longer in obese patients (mean time 93 min compared to 81 min; P = 0.0007), the main difficulty being gaining access because of their body habitus. All groups found the procedure to be effective in symptomatic outcome, 91% of obese patients compared to 92% of non-obese patients scored Visick I or II at 6 weeks' postoperatively. Similar Visick scoring was shown between the two groups at 6 months and 1 year, and in the morbidly obese group. CONCLUSIONS The outcome of laparoscopic anti-reflux surgery is similar between obese and non-obese patients with no trend towards a worse outcome in the obese or morbidly obese. Obesity should not be seen as a contra-indication, although it may be more technically challenging in this group of patients. Good results can be achieved in obese patients.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Booth

Stratford

et al. 2007

annals

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“…These varied results of weight loss on GERD symptoms could be because of small sample size, gender differences, wide variation in BMI of subjects (23 vs. 43), and use of different weight loss methods (various lifestyle changes vs. surgical approaches) (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Furthermore, a number of lifestyle intervention treatments have been attempted for GERD-low calorie diet, use of fruits/ vegetables, and physical activity; individually each intervention has no direct correlation with GERD improvement as shown in previous population-based studies (13,22,23) and a recent meta-analysis (32).…”

Section: Discussionmentioning

confidence: 99%

“…Previous data on the impact of weight loss achieved through various lifestyle (dietary changes and physical activity) (21)(22)(23)(24)(25) or surgical methods (Roux-en-Y gastric bypass or vertical band gastroplasty) (26)(27)(28)(29)(30) on GERD symptoms are scarce and with conflicting results (31). A systematic review evaluating the effects of various life style changes on GERD symptoms suggested that weight loss and head of bed elevation could improve symptoms of GERD (32).…”

Section: Introductionmentioning

confidence: 99%

Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial

Singh¹,

Lee²,

Gupta³

et al. 2012

Obesity

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Objective-Weight gain is an important risk factor for gastroesophageal reflux disease (GERD); however, whether weight loss can lead to resolution of GERD symptoms is not clear. Our aim was to measure the impact of weight loss on GERD symptoms.Design and Methods-In a prospective cohort study at a tertiary referral center, overweight/ obese subjects (BMI 25-39.9 kg/m2) were enrolled in a structured weight loss program. Weight loss strategies included dietary modifications, increased physical activity and behavioral changes. At baseline and at 6 months, BMI and waist circumference were measured and all participants completed a validated reflux disease questionnaire.Results-A total of 332 adult subjects, mean age 46 years and 66% women were prospectively enrolled. At baseline, the mean body weight, BMI, and waist circumference were 101 (±18) kg, 35 (±5) kg/m2 and 103 (±13) cm. At 6 months, majority of the subjects (97%) lost weight (average weight loss: 13 ± 7.7 kg) and as compared with baseline, there was a significant decrease in the overall prevalence of GERD (15 vs. 37%; P < 0.01) and the mean GERD symptom score (1.8 vs. 5.5; P < 0.01). Overall, 81% of the subjects had reduction in GERD symptom scores; 65% had complete resolution and 15% had partial resolution of reflux symptoms. There was a significant correlation between % body weight loss and reduction in GERD symptom scores (r = 0.17, P < 0.05).Conclusions-In conclusion, the overall prevalence of GERD symptoms is high (37%) in overweight and obese subjects. A structured weight loss program can lead to complete resolution of GERD symptoms in the majority of these subjects.

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“…In 2002, Frezza and colleagues 23 assessed changes in GERD symptoms following LRYGB. 23 Of 152 patients who participated in the study, follow-up revealed an EWL of 64% and a significant reduction in GERD symptoms at 12-month follow-up (heartburn: 87%-22%, p < 0.001; water brash: 18%-7%, p < 0.05; wheezing: 40%-5%, p < 0.001; laryngitis: 17%-7%, p < 0.05; aspiration: 14%-2%; use of proton pump inhibitors: 44%-9%, p < 0.001; and use of H2 blockers: 60%-10%, p < 0.01).…”

Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%

The effect of bariatric surgery on gastroesophageal reflux disease

Elhadi

Birch²,

Gill

et al. 2014

cjs

101

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Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass

Abstract: LRYGBP results in very good control of GERD in morbidly obese patients with follow-up as late as 3 years. Morbidly obese patients who require surgery for GERD may be better served by LRYGBP than fundoplication because of the additional benefit of significant weight loss.

Cited by 276 publications

References 29 publications

Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Laparoscopic Anti-Reflux Surgery is Effective in Obese Patients with Gastro-Oesophageal Reflux Disease

Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial

The effect of bariatric surgery on gastroesophageal reflux disease

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