Skip to main content
SpringerLink
Log in

Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Evolution of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) is controversial. Some authors report worsening or improvement of preoperative GERD, others the occurrence of de novo GERD between 5 and 69%.

Aims

The aims of this study are to evaluate the evolution of GERD after SG by ambulatory 24-h pH monitoring (APM) and to determine pre- and postoperative clinical and manometric factors associated with its evolution.

Methods

Between 2013 and 2015, 47 patients operated in our center performed APM before and 1 year (14.8 ± 4.9 months) after SG. GERD was defined as a percentage of time with esophageal pH < 4 (TpH < 4) > 4.2. Among them, 30 had pre- and postoperative high-resolution esophageal manometry (HRM).

Results

Thirty-one patients (66%) had no preoperative GERD (group 1), and 16 had preoperative GERD (group 2). One year after SG, mean TpH < 4 increased significantly in group 1 (5.8 ± 4.6 vs. 1.8 ± 1.1%, p < 0.01) whereas it was not modified in group 2 (7.4 ± 6.6 vs. 6.6 ± 2.6%). In group 1, 16 patients (52%) had de novo GERD whereas in group 2, 7 had no more GERD, 3 improved, and 6 worsened. Maximal intragastric pressure after swallows increased significantly at postoperative HRM only in patients with de novo GERD (49.2 ± 22.0 vs. 25.4 ± 9.4 mmHg, p = 0.03). No preoperative clinical or manometric parameters were predictive of postoperative GERD.

Conclusions

One year after SG, esophageal acid exposure globally worsened, mostly because of de novo GERD, whereas 63% patients with preoperative GERD improved, without preoperative predictive clinical or manometric factor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2666-x.

  2. Coupaye M, Rivière P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24:276–83.

    Article  PubMed  Google Scholar 

  3. Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13:568–74.

    Article  PubMed  Google Scholar 

  4. Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2748-9.

  5. Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol. 2015;21(36):10348–57.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khan A, Kim A, Sanossian C, et al. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol. 2016;22:1627–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mion F, Dargent J. Gastro-oesophageal reflux disease and obesity: pathogenesis and response to treatment. Best Pract Res Clin Gastroenterol. 2014;28:611–22.

    Article  PubMed  Google Scholar 

  8. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.

    Article  PubMed  Google Scholar 

  9. Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:569–72.

    Article  PubMed  Google Scholar 

  10. Soricelli E, Iossa A, Casella G, et al. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9:356–61.

    Article  PubMed  Google Scholar 

  11. DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014;149:328–34.

    Article  PubMed  Google Scholar 

  12. Nocca D, Loureiro M, Skalli EM, et al. Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity. Surg Endosc. 2017;31:3251–7.

    Article  PubMed  Google Scholar 

  13. Chopra A, Chao E, Etkin Y, et al. Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surg Endosc. 2012;26:831–7.

    Article  PubMed  Google Scholar 

  14. Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2014;10:502–7.

    Article  PubMed  Google Scholar 

  15. Sucandy I, Chrestiana D, Bonanni F, et al. Gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy for morbid obesity. The importance of preoperative evaluation and selection. N Am J Med Sci. 2015;7:189–93.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211:250–67.

    Article  PubMed  Google Scholar 

  17. Georgia D, Stamatina T, Maria N, et al. 24-h multichannel intraluminal impedance PH-metry 1 year after laparocopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease. Obes Surg. 2017;27:749–53.

    Article  PubMed  Google Scholar 

  18. Thereaux J, Barsamian C, Bretault M, et al. pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy. Br J Surg. 2016;103:399–406.

    Article  CAS  PubMed  Google Scholar 

  19. Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260:909–14.

    Article  PubMed  Google Scholar 

  20. Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc. 2015;29:1760–8.

    Article  PubMed  Google Scholar 

  21. Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg. 2014;24:1436–41.

    Article  PubMed  Google Scholar 

  22. Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24:71–7.

    Article  PubMed  Google Scholar 

  23. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20:357–62.

    Article  PubMed  Google Scholar 

  24. Petersen WV, Meile T, Küper MA, et al. Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity. Obes Surg. 2012;22:360–6.

    Article  PubMed  Google Scholar 

  25. Kleidi E, Theodorou D, Albanopoulos K, et al. The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: can it be minimized? Surg Endosc. 2013;27:4625–30.

    Article  PubMed  Google Scholar 

  26. Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26:2449–56.

    Article  PubMed  Google Scholar 

  27. Kahrilas PJ, Bredenoord AJ, Fox M, et al. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  PubMed  Google Scholar 

  28. Nicodème F, Pipa-Muniz M, Khanna K, et al. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–60.

    Article  PubMed  Google Scholar 

  29. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986;8(Suppl 1):52–8.

    Article  PubMed  Google Scholar 

  30. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:182–7.

    Article  PubMed  Google Scholar 

  31. Rebecchi F, Allaix ME, Patti MG, et al. Gastroesophageal reflux disease and morbid obesity: to sleeve or not to sleeve? World J Gastroenterol. 2017;23:2269–75.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ece I, Yilmaz H, Acar F, et al. A new algorithm to reduce the incidence of gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27:1460–5.

    Article  PubMed  Google Scholar 

  33. Moon RC, Teixeira AF, Jawad MA. Safety and effectiveness of anterior fundoplication sleeve gastrectomy in patients with severe reflux. Surg Obes Relat Dis. 2017;13:547–52.

    Article  PubMed  Google Scholar 

  34. Snyder B, Wilson E, Wilson T, et al. A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair. Surg Obes Relat Dis. 2016;12:1681–8.

    Article  PubMed  Google Scholar 

  35. Arman GA, Himpens J, Dhaenens J, et al. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1778–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, France

    Muriel Coupaye, Ouidad Sami & Séverine Ledoux

  2. Service de Gastroentérologie, Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, France

    Caroline Gorbatchef & Benoit Coffin

  3. Service de Chirurgie and Centre Intégré Nord Francilien de prise en charge de l’Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, France

    Daniela Calabrese & Simon Msika

Authors
  1. Muriel Coupaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline Gorbatchef
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Calabrese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ouidad Sami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simon Msika
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Benoit Coffin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Séverine Ledoux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muriel Coupaye.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coupaye, M., Gorbatchef, C., Calabrese, D. et al. Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study. OBES SURG 28, 838–845 (2018). https://doi.org/10.1007/s11695-017-2942-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2942-9

Keywords

Search

Navigation