Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are common bariatric surgeries that can alter physiological barriers against gastroesophageal reflux disease (GERD). We investigated the prevalence and potential physiologic underpinnings of erosive esophagitis (EE) after bariatric surgery in a large cohort with long-term follow-up.
This is a retrospective analysis of 517 patients who underwent an esophagogastroduodenoscopy after SG or RYGB. A matched case-control sub-study was conducted to compare physiologic contributors of GERD after SG with a pre-operative cohort using high-resolution manometry.
Consecutive post-SG and post-RYGB patients (body mass index (BMI) 34 ± 9.1 kg/m2, age 49 ± 12.4 years, 83% female) were included. EE was more prevalent after SG than RYGB (37.9% vs. 17.6%, p = 0.0001), including severe EE (10.7% vs. 3.1%, p = 0.0007). Post-SG EE remained more prevalent after adjusting for multiple confounders (OR = 2.47, p = 0.0012). In a matched case-control analysis, prevalence of EE was 31% in 39 SG patients compared with 13% in 40 pre-bariatric surgery patients with GERD and obesity (p = 0.044). Significant physiologic changes conducive to GERD was observed after SG including (1) decrease resting lower esophageal sphincter (LES) (mmHg) pressure (21.3 ± 14.1 vs. 39.8 ± 35.6, p = 0.004), and (2) lower maximal distal contractile integral (DCI) (mmHg-s-cm) (3814.8 ± 2684.8 vs. 5111.8 ± 7713, p = 0.034).
EE is more prevalent after SG compared with RYGB in a pre-bariatric surgery cohort with GERD. SG is associated with significant esophageal physiologic changes conducive to GERD and its clinical consequences.
KeywordsGERD Bariatric surgery Erosive esophagitis Sleeve gastrectomy Roux-en-Y gastric bypass PPI Hiatal hernia
Compliance with Ethical Standards
Conflict of Interest
Barham K. Abu Dayyeh reports personal fees from USGI Medical, grants from Apollo Endosurgery, personal fees from Johnson and Johnson, personal fees from Olympus, grants and personal fees from Boston Scientific, during the conduct of the study. Other authors declare that they have no conflict of interest.
This study was approved by institutional IRB.
For this type of study, formal consent was not required.
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