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Gastroesophageal Reflux After Sleeve Gastrectomy: New Onset and Effect on Symptoms on a Prospective Evaluation

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Abstract

Background

Gastroesophageal reflux disease (GERD) is present in half of the obese candidates for bariatric surgery. Variability of symptoms and new onset of GERD are often debated. Prior studies have demonstrated that sleeve gastrectomy (SG) is associated with significant weight loss.

Objectives

We prospectively evaluated the effect of a standardized SG technique on GERD symptoms in 104 patients.

Methods

All patients were surveyed on the presence of heartburn and/or regurgitation with a specific questionnaire (GERD-HRQL). Esophagogastroduodenoscopy (EGDS) was performed in the preoperative phase and after 12 months.

Results

All patients completed a 12-month follow-up. In the preoperative phase, 27.9% presented GERD symptoms (29 cases), while endoscopic findings were observed in 19.2% (20 cases). Preoperative GERD was ameliorated/solved in 65.5% of cases. The mean value of the GERD-HRQL score was significantly lower in postoperative evaluation (33.8 vs 19.4; p < 0.05). At 12-month EGDS, esophagitis was present in 13.5%, and GERD-HRQL symptoms were recorded in 10.6%. Considering patients treated until December 2015 (group 1, 44 patients) and those treated after December 2015 (group 2, 60 patients), all new clinical and endoscopic GERD diagnoses were observed in group 1; the majority of unsolved GERD cases was present in Ggoup 1 (8 vs 2; p < 0.05).

Conclusion

Significant amelioration on preoperative GERD was confirmed after SG. New characteristics of reflux are emerging in SG patients, often asymptomatic. Standardization is necessary to define the real effect of SG on GERD.

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Authors and Affiliations

  1. Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy

    Vincenzo Pilone

  2. General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy

    Vincenzo Pilone, Salvatore Tramontano & Michele Renzulli

  3. Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy

    Claudio Zulli

  4. Department of Cardio-Thoracic and Respiratory Science, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Luigi Schiavo

  5. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy

    Luigi Schiavo

Authors
  1. Vincenzo Pilone
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  2. Salvatore Tramontano
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  4. Claudio Zulli
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  5. Luigi Schiavo
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Correspondence to Salvatore Tramontano.

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The authors declare that they have no conflict of interest.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Specific informed consent was obtained by each patient, and the local Institutional Ethical Committee approved the study.

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Pilone, V., Tramontano, S., Renzulli, M. et al. Gastroesophageal Reflux After Sleeve Gastrectomy: New Onset and Effect on Symptoms on a Prospective Evaluation. OBES SURG 29, 3638–3645 (2019). https://doi.org/10.1007/s11695-019-04046-5

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  • DOI: https://doi.org/10.1007/s11695-019-04046-5

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