Current Gastroenterology Reports

, Volume 13, Issue 3, pp 205-212

First online:

Obesity and GERD: Pathophysiology and Effect of Bariatric Surgery

  • Radu TutuianAffiliated withDivision of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University HospitalUniversity Clinic for Visceral Surgery and Medicine, Bern University Hospital Email author 

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Epidemiologic, endoscopic, and pathophysiologic studies document the relationship between obesity and gastroesophageal reflux disease (GERD). Increased body mass index and accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms and esophageal lesions. Given this association, many studies were designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity. Among bariatric procedures, gastric sleeve and banded gastroplasty were shown to have no effect or even worsen reflux symptoms in the postoperative setting. Gastric banding improves reflux symptoms and findings (endoscopic and pH-measured distal esophageal acid exposure) in many patients, but is associated with de novo reflux symptoms or lesions in a considerable proportion of patients. To date, Roux-en-Y gastric bypass is the most effective bariatric procedure that consistently leads to weight reduction and improvement of GERD symptoms in patients undergoing direct gastric bypass and among those converted from restrictive bariatric procedures to gastric bypass.


Gastroesophageal reflux disease (GERD) Body mass index (BMI) Esophageal reflux monitoring Esophageal manometry Upper gastrointestinal endoscopy Proton pump inhibitors (PPI) Gastric banding Roux-en-Y gastric bypass Sleeve gastrectomy