Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass.

OBJECTIVE: To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity. METHODS: Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery. RESULTS: Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m2 vs. 42.7 ± 5.7 kg/m2; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78-40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9-52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6-44.8), and age (OR 2.0, 95%CI 1.1-3.4). CONCLUSIONS: One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.

Factors Associated to Abnormal Distal Esophageal Exposure to Acid and Esophagitis in Individuals Seeking Bariatric Surgery.

BACKGROUND: Gastroesophageal reflux disease (GERD) impacts choice and outcomes of bariatric surgery. However, GERD diagnosis based solely on symptoms yields inaccurate results. OBJECTIVE: To determine the factors associated with a positive 24h pH-monitoring (pH-test) or esophagitis in patients with severe obesity seeking bariatric surgery. SETTING: Private practice. METHODS: 93 patients with severe obesity underwent prospective evaluation for GERD symptoms, body composition, upper gastrointestinal endoscopy, esophageal manometry and pH-test. Correlation analyses were performed. RESULTS: 50 patients (53.8%) had GERD symptoms, 49 (52.7%) had esophagitis and 33 (35.5%) had a positive pH-test. Among patients with GERD symptoms, 18% had normal pH-test and no esophagitis, while 34.9% of patients without GERD symptoms had positive pH-test, esophagitis or both. Factors independently associated with positive pH-test were esophagitis (PR:3.08, 95%CI: 1.4-6.9, P = 0.006) and defective lower esophageal sphincter (PR:1.88, 95%CI: 1.09-3.21, P = 0.02). Factors independently associated with esophagitis were hiatal hernia (PR: 2.46; 95%CI: 1.6-3.7, P<0.001), GERD symptoms (PR:2.09; 95%CI: 1.3-3.4, P = 0.003) and positive pH-test (PR:1.82; 95%CI: 1.2-2.7, P = 0.003). The combined presence of GERD symptoms and esophagitis had a low positive predictive value for a positive pH-test (57%). On the other hand, the absence of both GERD symptoms and esophagitis had a 90% predictive value for a negative pH-test. CONCLUSIONS: Investigation for GERD before bariatric surgery should consist of routine upper endoscopy and GERD symptom evaluation in all patients. Patients with GERD symptoms and no esophagitis may need a pH-test for GERD diagnosis. Prospective studies are needed to understand significance of GERD diagnosis prior to bariatric surgery.