Advertisement

Surgery in the Morbidly Obese Patient with Gastroesophageal Reflux Disease (GERD)

  • Marco Di Corpo
  • Francisco Schlottmann
  • Marco G. PattiEmail author
Chapter

Abstract

Obesity rates have increased all over the world in the last three decades. Obesity and gastroesophageal reflux disease (GERD) are related. While a fundoplication is an excellent therapy in lean patients with GERD, outcomes may not be as good in morbidly obese patients. Therefore, bariatric surgery still remains the recommended treatment for GERD in this population. While all bariatric techniques may ameliorate GERD symptoms due to weight loss and a decrease in abdominal pressure, some operations like the sleeve gastrectomy may lead to a disruption of the antireflux mechanism and thus be a refluxogenic procedure. Conversely, the Roux-en-Y gastric bypass seems to be the appropriate option for patients who suffer from both diseases. Overall, understanding the pathophysiology of GERD in obese patients is essential for choosing the correct operation and achieving a successful outcome.

Keywords

Gastroesophageal reflux disease Obesity Transdiaphragmatic pressure gradient Body mass index Antireflux surgery Gastric sleeve Roux-en-Y gastric bypass 

Notes

Conflict of Interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28; quiz 329.PubMedCrossRefGoogle Scholar
  2. 2.
    Schlottmann F, Herbella FAM, Patti MG. Bariatric surgery and gastroesophageal reflux. J Laparoendosc Adv Surg Tech A. 2018;28(8):953–5.PubMedCrossRefGoogle Scholar
  3. 3.
    American Medical Association House of Delegates. Recognition of obesity as a disease. 2013. Accessible at http://www.npr.org/documents/2013/jun/ama-resolution-obesity.pdf.
  4. 4.
    Hampel HH, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.PubMedCrossRefGoogle Scholar
  5. 5.
    Herbella FA, Sweet MP, Tedesco P, et al. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Fisichella PM, Patti MG. Gastroesophageal reflux disease and morbid obesity: is there a relation? World J Surg. 2009;33(10):2034–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Nadaleto BF, Herbella FA, Patti MG. Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery. 2016;159(2):475–86.PubMedCrossRefGoogle Scholar
  8. 8.
    Andolfi C, Fisichella PM. Epidemiology of obesity and associated comorbidities. J Laparoendosc Adv Surg Tech A. 2018;28(8):919–24.PubMedCrossRefGoogle Scholar
  9. 9.
    NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387:1377–96.CrossRefGoogle Scholar
  10. 10.
    Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA. 2018;319(16):1723–5.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    El-Serag HB, Tran T, Richardson P, Ergun G. Anthropometric correlates of intragastric pressure. Scand J Gastroenterol. 2006;41:887–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Del Grande LM, Herbella FAM, Katayama RC, Schlottmann F, Patti MG. The role of the Transdiaphragmatic pressure gradient in the pathophysiology of gastroesophageal reflux disease. Arq Gastroenterol. 2018;55Suppl 1:13–7. pii: S0004-28032018005002102.PubMedCrossRefGoogle Scholar
  13. 13.
    Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013;9:920–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Patti MG, Goldberg HI, Arcerito M, et al. Hiatal hernia size affects the lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg. 1996;171:182–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Bello B, Herbella FA, Allaix ME, Patti MG. Impact of minimally invasive surgery on the treatment of benign esophageal disorders. World J Gastroenterol. 2012;18:6764–70.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007;21:1978–84.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Tandon A, Rao R, Hotouras A, Nunes QM, Hartley M, Gunasekera R, Howes N. Safety and effectiveness of antireflux surgery in obese patients. Ann R Coll Surg Engl. 2017;99(7):515–23.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Tekin K, Toydemir T, Yerdel MA. Is laparoscopic antireflux surgery safe and effective in obese patients? Surg Endosc. 2012;26:86–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Schietroma M, Piccione F, Clementi M, et al. short- and long-term, 11–22 years, results after laparoscopic nissen fundoplication in obese versus nonobese patients. J Obes. 2017;2017:7589408.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Abdelrahman T, Latif A, Chan DS, Jones H, Farag M, Lewis WG, Havard T, Escofet X. Outcomes after laparoscopic anti-reflux surgery related to obesity: a systematic review and meta-analysis. Int J Surg. 2018;51:76–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisichella PM, Patti MG. GERD procedures: when and what? J Gastrointest Surg. 2014;18(11):2047–53.PubMedCrossRefGoogle Scholar
  24. 24.
    Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol. 2016;22(4):1627–38.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Hariri K, Guevara D, Dong M, Kini SU, Herron DM, Fernandez-Ranvier G. Is bariatric surgery effective for co-morbidity resolution in the super-obese patients? Surg Obes Relat Dis. 2018;14:1261–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wong AM, Barnes HN, Joosten SA, Landry SA, Dabscheck E, Mansfield DR, Dharmage SC, Senaratna CV, Edwards BA, Hamilton GS. The effect of surgical weight loss on obstructive sleep apnoea: a systematic review and meta-analysis. Sleep Med Rev. 2018;42:85–99.PubMedCrossRefGoogle Scholar
  27. 27.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Miguel GP, Azevedo JL, de Souza PH, et al. Erosive esophagitis after bariatric surgery: banded vertical gastrectomy versus banded Roux-en-Y gastric bypass. Obes Surg. 2011;21:167–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Mandeville Y, Van Looveren R, Vancoillie PJ, et al. Moderating the enthusiasm of sleeve gastrectomy: up to fifty percent of reflux symptoms ten years in a consecutive series of 100 laparoscopic sleeve gastrectomies. Obes Surg. 2017;27:1797–803.PubMedCrossRefGoogle Scholar
  30. 30.
    Gorodner V, Buxhoeveden R, Clemente G, Solé L, Caro L, Grigaites A. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc. 2015;29(7):1760–8.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    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.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Gorodner V, Viscido G, Signorini F, Obeide L, Moser F. Gastroesophageal reflux disease and morbid obesity: evaluation and treatment. Updates Surg. 2018;70:331–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Salminen P, Helmio M, Ovaska J, et al. Effect of laparo- scopic sleeve gastrectomy vs laparoscopic Roux-en-Y gas- tric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319:241–54.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en- Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319:255–65.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Mason EE, Printen KJ, Hartford CE, Boyd WC. Optimizing results of gastric bypass. Ann Surg. 1975;182:405–14.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Pagé MP, Kastenmeier A, Goldblatt M, et al. Medically refractory gastro- esophageal reflux disease in the obese: what is the best surgical approach? Surg Endosc. 2014;28:1500–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Wang G, Agenor K, Pizot J, Kotler DP, Harel Y, Van Der Schueren BJ, et al. Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP). Obes Surg. 2012;22:1263–7.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Valezi AC, Herbella FA, Junior JM, de Almeida Menezes M. Esophageal motility after laparoscopic Roux-en-Y gastric bypass: the manometry should be preoperative examina- tion routine? Obes Surg. 2012;22:1050–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Tutuian R. Obesity and GERD: pathophysiology and effect of bariatric surgery. Curr Gastroenterol Rep. 2011;13(3):205–12.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    Langer FB, Bohdjalian A, Shakeri-Leidenmühler S, et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass–indications and outcome. Obes Surg. 2010;20:835–40.PubMedCrossRefGoogle Scholar
  42. 42.
    Mejia-Rivas MA, Herrera-Lopez A, Hernandez-Calleros J, Herrera MF, Valdovinos MA. Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18(10):1217–24.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Csendes A, Smok G, Burgos AM, Canobra M. Prospective sequential endoscopic and histologic studies of the gastric pouch in 130 morbidly obese patients submitted to Roux-en-Y gastric bypass. Arq Bras Cir Dig. 2012;25(4):245–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Soricelli E, Iossa A, Casella G, Abbatini F, Calı B, Basso N. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9:356–61.PubMedCrossRefGoogle Scholar
  45. 45.
    Oliveira DR. Incidence of regurgitation after the banded gastric bypass. Obes Surg. 2005;15:1408–17.PubMedCrossRefGoogle Scholar
  46. 46.
    Mahawar KK, Carr WR, Jennings N, Balupuri S, Small PK. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg. 2015;25:156–66.Google Scholar
  47. 47.
    Madalosso CA, Gurski RR, Callegari-Jacques SM, Navarini D, Thiesen V, Fornari F. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity: a prospective study based on the Montreal Consensus. Ann Surg. 2010;251:244–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Marco Di Corpo
    • 1
  • Francisco Schlottmann
    • 1
    • 2
  • Marco G. Patti
    • 3
    • 4
    Email author
  1. 1.Department of SurgeryUniversity of North CarolinaChapel HillUSA
  2. 2.Department of SurgeryHospital Alemán of Buenos Aires, University of Buenos AiresBuenos AiresArgentina
  3. 3.Department of SurgeryCenter for Esophageal Diseases and Swallowing, University of North CarolinaChapel HillUSA
  4. 4.Department of MedicineCenter for Esophageal Diseases and Swallowing, University of North CarolinaChapel HillUSA

Personalised recommendations