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Gastroesophageal Reflux Disease and Metabolic Surgery

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Abstract

The obesity pandemic, accompanied by a long list of obesity-related comorbid conditions and their profound impact on longevity and quality of life (QoL), continues to rise affecting 42.4% of adults in the United States (US) and over 650 million worldwide [1, 2]. Gastroesophageal reflux disease (GERD) is estimated to coexist in patients with obesity at rates ranging from 31.4% to 50.0% with its prevalence shown to increase with rising body mass index (BMI) [3, 4]. The prevalence of GERD in patients pursuing metabolic surgery may be even higher, affecting up to 62.4% [5]. As part of an interdisciplinary program, metabolic surgery is safe and the most effective treatment for obesity resulting in notable weight loss and comorbidity resolution [6]. The number of metabolic procedures performed in the US has steadily risen each year reaching 256,000 in 2019. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are most commonly employed accounting for 59.4% and 17.8% of metabolic operations [7]. Though many questions remain, it appears the effects of these procedures on GERD differ by operation type. Moreover, removal or exclusion of the fundus in SG and RYGB limits the options for addressing medically refractory GERD following metabolic surgery. This chapter provides an overview of the complex and incompletely understood relationship between metabolic surgery and GERD including its epidemiology, pathophysiology, presentation, and workup. The available evidence on procedures technically feasible in patients with refractory GERD after metabolic surgery is reviewed, and guiding principles for the management of this challenging and growing problem are offered.

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Authors and Affiliations

  1. Philadelphia, PA, USA

    R. Alvarez

  2. El Paso, TX, USA

    J. Silva

  3. Keck of USC, Los Angeles, CA, USA

    Caitlin Houghton

  4. Cleveland, OH, USA

    Leena Khaitan

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  1. R. Alvarez
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  2. J. Silva
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  3. Caitlin Houghton
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  4. Leena Khaitan
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Correspondence to Caitlin Houghton .

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Editors and Affiliations

  1. University of California, Irvine, Orange, CA, USA

    Ninh T. Nguyen

  2. Department of Gastroenterology & Hepatology, Stanford Digestive Health Clinic, Redwood City, CA, USA

    John O. Clarke

  3. Keck School of Medicine at USC, Los Angeles, CA, USA

    John C. Lipham

  4. Digestive Health Institute, University of California, Irvine, Orange, CA, USA

    Kenneth J. Chang

  5. Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York City, NY, USA

    Felice Schnoll-Sussman

  6. Institute of Esophageal & Reflux Surgery, Englewood, CO, USA

    Reginald C.W. Bell

  7. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Peter J. Kahrilas

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Alvarez, R., Silva, J., Houghton, C., Khaitan, L. (2023). Gastroesophageal Reflux Disease and Metabolic 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_60

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