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Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis

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Abstract

Background

Systemic sclerosis (scleroderma) is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility. Anti-reflux procedures in this patient population must account for the existing physiology of each patient and likely disease progression. We aim to compare perioperative and intermediate outcomes of fundoplication versus gastric bypass for the treatment of GERD.

Methods

After IRB approval, patients with systemic sclerosis undergoing fundoplication or gastric bypass for the treatment of GERD from 2004 to 2016 were identified. Demographics, perioperative data, immediate complications, and symptom improvement were retrieved and analyzed.

Results

Fourteen patients with systemic sclerosis underwent surgical treatment of GERD during the defined study period. Average body mass index was 26 kg/m2. Seven fundoplications (2 Nissens, 4 Toupets, and 1 Dor) and 7 Roux-en-Y gastric bypasses (RYGB) were performed. No 30-day mortality was observed in either group. Median follow-up was 97 months for the fundoplication group (range 28–204 months), and 19 months for the RYGB group (range 1–164 months). Preoperatively, dysphagia, heartburn, and regurgitation were present in 71% (n = 10), 86% (n = 12), and 64% (n = 9) of patients, respectively. Eleven patients had pH study prior to surgical intervention, and 91% of them had abnormal acid exposure. Esophagitis was evident in 85% (n = 11) of patients during preoperative upper endoscopy, and two patients had Barrett’s esophagus. Impaired esophageal motility was present in all RYGB patients and 71% of fundoplication patients. Of the patients who had assessment of their GERD symptoms at follow-up, all five patients in the RYGB group and only 3 (50%) patients in the fundoplication group reported symptom improvement or resolution.

Conclusions

Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients with esophageal dysmotility.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk A-100, Cleveland, OH, 44195, USA

    Jingliang Yan, Andrew T. Strong, Gautam Sharma, John Rodriguez & Matthew Kroh

  2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Andrew T. Strong, Scott Gabbard, Prashanti Thota, John Rodriguez & Matthew Kroh

  3. Department of Gastroenterology and Hepatology, Esophageal and Swallowing Disorders Center, Cleveland Clinic, Cleveland, OH, USA

    Scott Gabbard & Prashanti Thota

  4. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew Kroh

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  1. Jingliang Yan
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Correspondence to Jingliang Yan.

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Disclosures

Drs. Jingliang Yan, Andrew Strong, Gautam Sharma, Scott Gabbard, Prashanti Thota, John Rodriguez, and Matthew Kroh have no conflict of interest or financial ties to disclose.

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Yan, J., Strong, A.T., Sharma, G. et al. Surgical management of gastroesophageal reflux disease in patients with systemic sclerosis. Surg Endosc 32, 3855–3860 (2018). https://doi.org/10.1007/s00464-018-6115-2

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  • DOI: https://doi.org/10.1007/s00464-018-6115-2

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