Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 7:709-713

Department of Surgery, Minimally Invasive, Gastroesophageal and Bariatric Surgery Service, University of Florida, Gainesville, Florida 32610, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 08/2011; 7(6):709-13. DOI: 10.1016/j.soard.2011.08.003
Source: PubMed


Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients and a high body mass index is a risk factor for the development of this co-morbidity. The effect of laparoscopic sleeve gastrectomy (LSG) on GERD is poorly known.
We studied the effect of LSG on GERD in patients with morbid obesity. A retrospective review of 28 consecutive patients undergoing LSG for morbid obesity from September 2008 to September 2010 was performed.
A total of 28 patients, 18 women and 10 men, were identified, with a mean age of 42 years (range 18-60). The mean weight and body mass index was 166 kg and 55.5 kg/m2, respectively. The mean percentage of excess weight loss was 40% (range 17-83), with a mean follow-up time of 32 weeks (range 8-92). All patients had a pre- and postoperative upper gastrointestinal radiographic swallow study as a part of their routine care. Of these patients, 18% were noted to have new-onset GERD on their postoperative upper gastrointestinal swallow test after their LSG procedure. Using the GERD score questionnaire, all patients were interviewed to evaluate their reflux symptoms. We had a 64% response rate, with 22% of patients indicating new-onset GERD symptoms despite receiving daily antireflux therapy. All respondents were extremely happy with their surgery and weight loss to date.
LSG might increase the prevalence of GERD despite satisfactory weight loss. Additional studies evaluating esophageal manometry and ambulatory 24-hours pH-metry are needed to better evaluate the effect of LSG on gastroesophageal reflux symptoms.

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    • "Unlike traditional anti-reflux surgery or procedures, LES-EST does not adversely affect esophageal body function or LES relaxation and hence could be an important therapeutic alternative for GERD patients with esophageal dysmotility that are not adequately addressed by medical management. Furthermore, post-sleeve gastrectomy reflux is a new and rising subgroup of GERD patients that are inadequately treated with medication and are not a candidate for traditional anti-reflux surgery.36 These patients could be addressed with LES-EST and a pilot study will be started in our center to evaluate the effect of EST in patients with post-sleeve gastrectomy GERD. "
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    ABSTRACT: Electrical stimulation therapy (EST) of the lower esophageal sphincter is a relatively new technique for the treatment of gastroesophageal reflux disease (GERD) that may address the need of GERD patients, unsatisfied with acid suppressive medication and concerned with the potential risks of surgical fundoplication. In this paper we review available data about EST for GERD, including the development of the technique, implant procedure, safety and results from open-label trials. Two short-term temporary stimulation and long-term open label human trials each were initiated to investigate the safety and efficacy of EST for the treatment of GERD and currently up to 2 years follow-up results are available. The results of EST are promising as the open-label studies have shown that EST is a safe technique with a significant improvement in both subjective outcomes of symptoms and objective outcomes of esophageal acid exposure in patients with GERD. However, long term data from larger number of patients and a sham controlled trial are required before EST can be conclusively advised as a viable treatment option for GERD patients.
    Journal of neurogastroenterology and motility 05/2014; 20(3). DOI:10.5056/jnm13137 · 2.30 Impact Factor
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    • "Howard et. al. [18], who had a one year GERD rate of 21.0%, declare that all of their GERD patients were “extremely happy with their surgery” and “would choose the procedure again”. Despite Howard et. "
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    ABSTRACT: To evaluate changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG). We started the procedure in May 2007, and by December 2011, 117 patients could be evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients. Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomatic gastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively. LSG is an effective procedure for morbid obesity and obesity-related diseases, but the technique should be further explored particularly to avoid gastroesophageal reflux.
    BMC Surgery 02/2014; 14(1):8. DOI:10.1186/1471-2482-14-8 · 1.40 Impact Factor
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    • "Early post-SG GERD prevalence was increased 14.4% from the preoperative value, and late post-SG GERD was increased by 12.6%. Howard et al. [41] demonstrated a 14% increase with a mean follow-up time of 32 weeks. "
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    ABSTRACT: Bariatric surgery, when combined with lifestyle and medical interventions, is a common and successful treatment modality in the obese patient. Laparoscopic sleeve gastrectomy is one such procedure that has increased in popularity as a definitive bariatric operation. Although laparoscopic sleeve gastrectomy has been shown to be effective in producing weight loss and improving type 2 diabetes mellitus, its effect on gastroesophageal reflux disease (GERD) has been inconsistent. This paper aims to summarize the available literature regarding GERD prevalence following laparoscopic sleeve gastrectomy, 8 studies demonstrate increased GERD prevalence, and 5 demonstrate decreased GERD prevalence following laparoscopic sleeve gastrectomy. The relationship between GERD and SG is complex and no clear relationship exists. The anatomic and physiologic changes caused by laparoscopic sleeve gastrectomy are discussed in the context of these inconsistent results.
    Journal of obesity 07/2013; 2013:741097. DOI:10.1155/2013/741097
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