Abstract
Gastroesophageal reflux disease (GERD) and obesity are two of the most common digestive conditions, and the prevalence of GERD is high in those undergoing bariatric surgery [1]. Because of the high association between obesity and GERD, it is critically important to evaluate patients undergoing bariatric surgery for the presence of GERD in addition to the appropriate pre-operative work-up for bariatric surgery. The conventional diagnostic evaluation for GERD should involve objective testing, including esophageal manometry, upper gastrointestinal contrast study, upper endoscopy with pH testing, and, when clinically indicated, testing for other causes of GERD such as delayed gastric emptying. For patients presenting with severe obesity and GERD, it is important to provide counseling on the efficacy of bariatric surgery in potentially improving many obesity-related comorbidities, including type II diabetes, hypertension, hyperlipidemia, cardiovascular disease, and obstructive sleep apnea. However, outcomes for reflux disease following bariatric surgery are variable. Gastroesophageal reflux is one condition in which weight loss associated with bariatric surgery does not consistently improve outcomes [2–4]. This chapter aims to outline current surgical options in the management of patients with GERD undergoing bariatric surgery, discuss the potential pathophysiology of GERD associated with bariatric surgery, and highlight innovative strategies in the surgical management of patients presenting with GERD and severe obesity.
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References
Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013;9(6):920–4.
Lorentzen J, Medhus AW, Hofso D, et al. Sleeve gastrectomy confers higher risk of gastroesophageal reflux disease than gastric bypass: a randomized controlled trial from the Oseberg reflux working group. Gastroenterology. 2021;161(6):2044–2046.e4.
Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319(3):255–65.
Biter LU, van Buuren MMA, Mannaerts GHH, et al. Quality of life 1 tear after laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial focusing on gastroesophageal reflux disease. Obes Surg. 2017;27(10):2557–65.
Johari Y, Lim G, Wickremasinghe A, et al. Pathophysiological mechanisms of gastroesophageal reflux following sleeve gastrectomy. Ann Surg. 2022;276(5):e407–16.
Amor IB, Casanova V, Vanbiervliet G, et al. The Nissen-sleeve (N-Sleeve): results of a cohort study. Obes Surg. 2020;30(9):3267–72.
Nocca D, Nedelcu M, Loureiro M, et al. The Nissen Sleeve gastrectomy: technical considerations. J Laparoendosc Adv Surg Tech A. 2020;30(11):1231–6.
Nadaleto BF, Herbella FA, Patti MG. Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery. 2016;159(2):475–86.
Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24(11):2647–69.
Little AG. Mechanisms of action of antireflux surgery: theory and fact. World J Surg. 1992;16(2):320–5.
Hill L, Kozarek RA. The gastroesophageal flap valve. J Clin Gastroenterol. 1999;28:194–7.
Herbella FA, Schiottmann F, Patti MG. Pathophysiology of gastroesophageal reflux disease: how an antireflux procedure works (or does not work). Updat Surg. 2018;70(3):343–7.
Slater BJ, Dirks RC, Mckinley SK, et al. SAGES guidelines for the surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2021;35:4903–17.
Jiang Y, Sandler B, Bhargava V, Mittal RK. Antireflux action of Nissen fundoplication and stretch-sensitive mechanism of lower esophageal sphincter relaxation. Gastroenterology. 2011;140(2):442–9.
Ali M, El Chaar M, Dhiassi S, et al. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652–7.
Choy AY, Roccato MK, Samarasena JB, et al. Novel interdisciplinary approach to GERD: concomitant laparoscopic hiatal hernia repair with transoral incisionless fundoplication. J Am Coll Surg. 2021;232(3):309–18.
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Nguyen receives honoraria as a speaker for Endogastric Solutions and Olympus.
Chang receives honoraria from Apollo, Boston Scientific, C2 Therapeutics, Cook Medical, Covidien, Endogastric Solutions, Erbe, Mederi, Medtronic, Mauna Kea, Olympus, Ovsco, Nine Point, Pentax, and Torax.
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Nguyen, N.T., Runge, A., Chang, K.J. (2023). Strategies in Management of GERD in the Severely Obese Undergoing Bariatric Surgery. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_56
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DOI: https://doi.org/10.1007/978-3-031-19671-3_56
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