Skip to main content
SpringerLink
Log in

Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database

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

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

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
Fig. 3

Similar content being viewed by others

References

  1. Ozanan M. Laparoscopic sleeve gastrectomy. J Med Insight. 2017;

  2. Kayaalp C, Sümer F, Abdullayev A. Laparoscopic Roux-en-Y gastric bypass. Laparosc Endosc Surg Sci. 2016;23(4):110–8.

    Google Scholar 

  3. Sheppard CE, Sadowski DC, de Gara CJ, et al. Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg. 2015;25(5):763–8.

    Article  PubMed  Google Scholar 

  4. Kindel TL, Oleynikov D. The improvement of gastroesophageal reflux disease and Barrett's after bariatric surgery. Obes Surg. 2016;26(4):718–20.

    Article  PubMed  Google Scholar 

  5. Barr AC, Frelich MJ, Bosler ME, et al. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy. Surg Endosc. 2017;31(1):410–5.

    Article  PubMed  Google Scholar 

  6. Laffin M et al. Sleeve gastrectomy and gastroesophageal reflux disease. J Obes. 2013;2013:741097–7.

    Article  Google Scholar 

  7. Carabotti M, Avallone M, Cereatti F, et al. Usefulness of upper gastrointestinal symptoms as a driver to prescribe gastroscopy in obese patients candidate to bariatric surgery. A prospective study. Obes Surg. 2016;26(5):1075–80.

    Article  PubMed  Google Scholar 

  8. Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(6):751–6.

    Article  PubMed  Google Scholar 

  9. Lim CH, Lee PC, Lim E, et al. Correlation between symptomatic gastro-esophageal reflux disease (GERD) and erosive esophagitis (EE) post-vertical sleeve gastrectomy (VSG). Obes Surg. 2019;29(1):207–14.

    Article  PubMed  Google Scholar 

  10. Santo MA et al. Endoscopic changes related to gastroesophageal reflux disease: comparative study among bariatric surgery patients. Arq Bras Cir Dig. 2015;28(Suppl 1):36–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Estevez-Fernandez S et al. Esophagogastric pathology in morbid obese patient: preoperative diagnosis, influence in the selection of surgical technique. Rev Esp Enferm Dig. 2015;107(7):408–12.

    PubMed  Google Scholar 

  12. Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc. 2013;27(4):1260–6.

    Article  PubMed  Google Scholar 

  13. Czeczko LE et al. Correlation between pre and postoperative upper digestive endoscopy in patients who underwent roux-en-y gastrojejunal bypass. Arq Bras Cir Dig. 2016;29(1):33–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Miguel GP et al. Erosive esophagitis after bariatric surgery: banded vertical gastrectomy versus banded Roux-en-Y gastric bypass. Obes Surg. 2011;21(2):167–72.

    Article  PubMed  Google Scholar 

  15. Braghetto I, Korn O, Csendes A, et al. Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett’s esophagus: a prospective study. Obes Surg. 2012;22(5):764–72.

    Article  PubMed  Google Scholar 

  16. Csendes JA et al. Effects of gastric bypass on erosive esophagitis in obese subjects. Rev Med Chil. 2006;134(3):285–90.

    Article  Google Scholar 

  17. 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(3):357–62.

    Article  PubMed  Google Scholar 

  18. El-Hadi M et al. The effect of bariatric surgery on gastroesophageal reflux disease. Can J Surg. 2014;57(2):139–44.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Del Genio G et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24(1):71–7.

    Article  PubMed  Google Scholar 

  20. Xu XR, Li ZS, Zou DW, et al. Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms. Can J Gastroenterol. 2006;20(2):91–4.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li MJ, Li Q, Sun M, et al. Comparative effectiveness and acceptability of the FDA-licensed proton pump inhibitors for erosive esophagitis: a PRISMA-compliant network meta-analysis. Medicine (Baltimore). 2017;96(39):e8120.

    Article  CAS  Google Scholar 

  22. Ali, M., el Chaar M., Ghiassi S., Rogers A.M., American Society for Metabolic and Bariatric Surgery Clinical Issues Committee., American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis, 2017. 13(10): p. 1652–1657.

  23. Quezada N, Hernández J, Pérez G, et al. Laparoscopic sleeve gastrectomy conversion to Roux-en-Y gastric bypass: experience in 50 patients after 1 to 3 years of follow-up. Surg Obes Relat Dis. 2016;12(8):1611–5.

    Article  PubMed  Google Scholar 

  24. Jones Jr KB. Roux-en-Y gastric bypass: an effective antireflux procedure in the less than morbidly obese. Obes Surg. 1998;8(1):35–8.

    Article  PubMed  Google Scholar 

  25. Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997;7(6):479–84.

    Article  CAS  PubMed  Google Scholar 

  26. Perry, Y., et al., Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. Jsls, 2004. 8(1): p. 19–23.

  27. Namikawa T, Kitagawa H, Okabayashi T, et al. Roux-en-Y reconstruction is superior to billroth I reconstruction in reducing reflux esophagitis after distal gastrectomy: special relationship with the angle of his. World J Surg. 2010;34(5):1022–7.

    Article  PubMed  Google Scholar 

  28. Berger EH. The distribution of parietal cells in the stomach: a histotopographic study. Am J Anat. 1934;54(1):87–114.

    Article  Google Scholar 

  29. Smith CD, Herkes SB, Behrns KE, et al. Gastric acid secretion and vitamin B12 absorption after vertical roux-en-Y gastric bypass for morbid obesity. Ann Surg. 1993;218(1):91–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Fein M et al. Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease. J Gastrointest Surg. 1999;3(4):405–10.

    Article  CAS  PubMed  Google Scholar 

  31. van Herwaarden MA, Samsom M, Smout AJ. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Gastroenterology. 2000;119(6):1439–46.

    Article  PubMed  Google Scholar 

  32. Kahrilas PJ, Shi G, Manka M, et al. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia. Gastroenterology. 2000;118(4):688–95.

    Article  CAS  PubMed  Google Scholar 

  33. Gulkarov I, Wetterau M, Ren CJ, et al. Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation. Surg Endosc. 2008;22(4):1035–41.

    Article  PubMed  Google Scholar 

  34. Kahrilas PJ. The role of hiatus hernia in GERD. The Yale J Biol Med. 1999;72(2–3):101–11.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN, USA

    Reem Matar, Daniel Maselli, Eric Vargas, Jaruvongvanich Veeravich, Fateh Bazerbachi, Azizullah Beran, Andrew C. Storm & Barham K. Abu Dayyeh

  2. Division of Surgery, Mayo Clinic, Rochester, MN, USA

    Todd Kellogg

Authors
  1. Reem Matar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Maselli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaruvongvanich Veeravich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fateh Bazerbachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Azizullah Beran
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew C. Storm
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Todd Kellogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Barham K. Abu Dayyeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barham K. Abu Dayyeh.

Ethics declarations

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.

Ethical Approval

This study was approved by institutional IRB.

Informed Consent

For this type of study, formal consent was not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matar, R., Maselli, D., Vargas, E. et al. Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database. OBES SURG 30, 161–168 (2020). https://doi.org/10.1007/s11695-019-04164-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04164-0

Keywords

Search

Navigation