Skip to main content
SpringerLink
Log in

Gastroesophageal Reflux Disease in Morbid Obesity: The Effect of Roux-en-Y Gastric Bypass

  • Research Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

Gastroesophageal reflux disease (GERD) is a common condition in obesity. The impact of Roux-en-Y gastric bypass (RYGBP) on GERD is poorly known. We studied the effect of the RYGBP on GERD in patients with morbid obesity (MO).

Methods

Twenty consecutive patients with MO (BMI > 40 kg/m2) were studied before and 6 months after RYGBP. GERD symptoms were evaluated with Carlsson–Dent questionnaire (CDQ). All the patients underwent esophageal manometry and ambulatory 24-h pH-metry. Chi-square test was used to compare categorical variables, and Wilcoxon test was used for numerical variables. A p value under 0.05 was considered significant.

Results

There were 16 women (80%) and 4 men (20%) with mean age 38.9 ± 6.9 years included in this study. BMI was 48.5 ± 6.2 kg/m2 and 33.2 ± 4.5 kg/m2 before and after RYGBP, respectively. Mean weight reduction was 42.5 ± 9.7 kg (p < 0.001). Reflux symptoms measured by CDQ and esophageal acid exposure improved significantly after RYGBP. The percentage of time of pH < 4 was 10.7 ± 6.7 before and 1.6 ± 1.2 after the surgical procedure (p < 0.001). LES basal pressure before and after the RYGBP was 18 ± 11 and 20.1 ± 5.6 mmHg (p = 0.372), and the esophageal body amplitude was 104.2 ± 47.2 and 75.1 ± 36.2 mmHg, respectively (p = 0.005).

Conclusion

RYGBP improves GERD symptoms and reduces esophageal acid exposure in patients with MO.

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
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Sánchez C, Pichardo E, López P. Prevalencia de la obesidad. Gac Med Mex. 2004;140:S3–20.

    Google Scholar 

  2. Must A, Spadano J, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282:1530–8.

    Article  Google Scholar 

  3. Lundell L, Ruth M, et al. Does massive obesity promote abnormal gastro-esophageal reflux? Dig Dis Sci. 1995;40:1632–5.

    Article  PubMed  CAS  Google Scholar 

  4. Fisher BL, Pennathru A, et al. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290–4.

    Article  PubMed  CAS  Google Scholar 

  5. Gómez Escudero O, Herrera Hernández M, Valdovinos Díaz MA. Obesidad y enfermedad por reflujo gastroesófagico. Rev Invest Clin. 2002;54(4):320–7.

    PubMed  Google Scholar 

  6. Hagen J, Deitel M, Khanna RK, et al. Gastroesophageal reflux in the massively obese. Int Surg. 1987;72:1–3.

    PubMed  CAS  Google Scholar 

  7. Rigaud D, Merrouche M, Le Möel G, et al. Factors of gastroesophageal acid reflux in severe obesity. Gastroenterol Clin Biol. 1995;19:818–25.

    PubMed  CAS  Google Scholar 

  8. Wajed SA, Streets CG, Bremmer CG, et al. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–9.

    Article  PubMed  CAS  Google Scholar 

  9. Merced CD, Wren SF, DaCosta LR, et al. Lower esophageal sphincter pressure gradients in excessively obese patients. J Med. 1987;18:135–46.

    Google Scholar 

  10. Wisen O, Hellstrom PM. Gastrointestinal motility in obesity. J Intern Med. 1995;237:411–8.

    Article  PubMed  CAS  Google Scholar 

  11. Quiroga E, Cuenca-Abente F, Flum D, et al. Impaired esophageal function in morbidly obese patients with gastroesophageal reflux disease: evaluation with multichannel intraluminal impedance. Surg Endosc. 2006;20(5):739–43.

    Article  PubMed  CAS  Google Scholar 

  12. Jaffin BW, Knoepflmacher P, et al. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.

    Article  PubMed  CAS  Google Scholar 

  13. Hong D, Yashodhan S, et al. Manometric abnormalities and gastro-esophageal reflux disease in the morbidly obese. Obes Surg. 2004;14:744–9.

    Article  PubMed  Google Scholar 

  14. Suter M, Dorta G, et al. Gastro-esophageal reflux disease and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.

    Article  PubMed  CAS  Google Scholar 

  15. Di Francesco V, Baggio E, Mastrmauro M, et al. Obesity and gastroesophageal acid reflux: physiopathological mechanisms and role of bariatric surgery. Obes Surg. 2004;14(8):1095–02.

    Article  Google Scholar 

  16. Weiss HG, Nehoda H, et al. Treatment or morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg. 2000;180:479–82.

    Article  PubMed  CAS  Google Scholar 

  17. Suter M, Dorta G, et al. Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg. 2005;140(7):639–43.

    Article  PubMed  Google Scholar 

  18. Klaus A, Gruber I, Wetscher G, et al. Prevalent esophageal body motility disorders underlie aggravation of GERD symptoms in morbidly obese patients following adjustable gastric banding. Arch Surg. 2006;141(3):247–51.

    Article  PubMed  Google Scholar 

  19. Ovrebo KK, Hatlebakk JG, Viste A, et al. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty. Ann Surg. 1998;228(1):51–8.

    Article  PubMed  CAS  Google Scholar 

  20. Balduyck B, Vansteenkiste S, Ruppert M, et al. The evaluation of pyrosis and long-term satisfaction after gastric restrictive procedures: a retrospective study. Acta Chir Belg. 2005;105(2):161–7.

    PubMed  CAS  Google Scholar 

  21. Lundell L, Ruth M, Olbe L. Vertical banded gastroplasty or gastric banding for morbid obesity: effects on gastro-esophageal reflux. Eur J Surg. 1997;163(7):525–31.

    PubMed  CAS  Google Scholar 

  22. Naslund E, Granstrom L, Melcher A, et al. Gastro-oesophageal reflux before and after vertical banded gastroplasty in the treatment of obesity. Eur J Surg. 1996;162:303–6.

    PubMed  CAS  Google Scholar 

  23. Deitel M, Khanna RK, Hagen J, et al. Vertical banded gastroplasty as an antireflux procedure. Am J Surg. 1998;155:512–6.

    Article  Google Scholar 

  24. Smith SC, Edwards CB, et al. Symptomatic and clinical improvement in morbidly obese patients with gastro-esophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997;7:479–84.

    Article  PubMed  CAS  Google Scholar 

  25. Foster A, Laws HL, Gonzalez QH, et al. Gastrointestinal symptomatic outcome after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2003;7(6):750–3.

    Article  PubMed  Google Scholar 

  26. Heading RC. Epidemiology of esophageal reflux disease. Scand J Gastroenterol. 1989;168 Suppl:S33–7.

    Google Scholar 

  27. Frase-Moodie CA, Norton B, Gorall C, et al. Weight loss has an independent beneficial effect on symptoms of gastro-esophageal reflux in patients who are overweight. Scand J Gastroenterol. 1999;34:337–40.

    Article  Google Scholar 

  28. Mathus-Vliegen LM, Tytgat GN. Twenty-four-hour pH measurements in morbid obesity: effects of massive overweight, weight loss and gastric distension. Eur J Gastroenterol Hepatol. 1996;8:625–6.

    Google Scholar 

  29. Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1027–31.

    Article  PubMed  CAS  Google Scholar 

  30. Ortega J, Escudero MD, Mora F, et al. Outcome of esophageal function and 24-hour esophageal pH monitoring after vertical banded gastroplasty and Roux-en-Y gastric bypass. Obes Surg. 2004;14:1086–94.

    Article  PubMed  Google Scholar 

  31. Balsiger BM, Murr MM, Mai J, et al. Gastroesophageal reflux after intact vertical banded gastroplasty: correction by conversion to Roux-en Y gastric bypass. J Gastrointest Surg. 2000;4:276–81.

    Article  PubMed  CAS  Google Scholar 

  32. Kim CH, Sarr MG. Severe reflux esophagitis after vertical banded gastroplasty for treatment of morbid obesity. Mayo Clin Proc. 1992;67:33–5.

    PubMed  CAS  Google Scholar 

  33. Bloomberg RD, Urbach DR. Laparoscopic Roux-en-Y gastric bypass for severe gastroesophageal reflux after vertical banded gastroplasty. Obes Surg. 2002;12:408–11.

    Article  PubMed  Google Scholar 

  34. Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS. 2004;8(1):19–23.

    PubMed  Google Scholar 

  35. Jones KB Jr, Allen TV, Manas KJ, et al. Roux-en-Y gastric bypass: an effective anti-reflux procedure. Obes Surg. 1991;1:295–8.

    Article  PubMed  Google Scholar 

  36. Clements RH, Gonzalez QH, Foster A, et al. Gastrointestinal symptoms are more intense in morbidly obese patients and are improved with laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13(4):610–4.

    Article  PubMed  Google Scholar 

  37. Jones KB Jr. Roux-en-Y gastric bypass: an effective anti-reflux procedure in the less than morbidly obese. Obes Surg. 1998;8:35–8.

    Article  PubMed  Google Scholar 

  38. Patterson EJ, Khajanchee YS, Swanstrom LL, et al. Objective assessment of the effect of laparoscopic gastric bypass on esophageal pH and motility in morbidly obese patients with GERD. Obes Surg. 2001;11:408 (abst 102).

    Google Scholar 

  39. Jong JR, Ramshorts B, Timmer R, et al. Effect of laparoscopic gastric banding on esophageal motility. Obes Surg. 2006;16:52–8.

    Article  PubMed  Google Scholar 

  40. Tolonen P, Victorzon M, Niemi R, et al. Does gastric banding for obesity reduce or increase gastroesophageal reflux? Obes Surg. 2006;16:1469–74.

    Article  PubMed  Google Scholar 

  41. Stene-Larsen G, Weberg R, Froyshov-Larsen I, et al. Relationship of overweight to hiatus hernia and reflux esophagitis. Scand J Gastroenterol. 1988;23:427–32.

    Article  PubMed  CAS  Google Scholar 

  42. Kahrilas P, Shi G, Manka M, et al. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatus hernia. Gastroenterol. 2000;118:688–95.

    Article  CAS  Google Scholar 

  43. Kahrilas P, Wu S, Lin SH. Attenuation of esophageal shortening during peristalsis with hiatus hernia. Gastroenterol. 1995;109:1818–25.

    Article  CAS  Google Scholar 

  44. Sloan SH, Kahrilas P. Impairment of esophageal emptying with hiatus hernia. Gastroenterol. 1991;100:596–605.

    CAS  Google Scholar 

  45. Maddox A, Horowitz M, Wishart J, et al. Gastric and esophageal emptying in obesity. Scand J Gastroenterol. 1989;24:593–8.

    Article  PubMed  CAS  Google Scholar 

  46. Merced CD, Rue C, Hanelin L, et al. Effect of obesity on esophageal transit. Am J Surg. 1985;149:177–81.

    Article  Google Scholar 

  47. Smith CD, Herkes SB, Behrm KE. Gastric acid secretion and vitamin B 12 absorption after vertical Roux en-Y gastric bypass for morbid obesity. Ann Surg. 1993;218:91–9.

    Article  PubMed  CAS  Google Scholar 

  48. Achem S, Kolts B, Wears R, et al. Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux. Am J Gastroenterol. 1993;88(2):187–92.

    PubMed  CAS  Google Scholar 

  49. Vinjirayer E, González B, Brensinger C, et al. Ineffective motility is not a marker for gastroesophageal reflux disease. Am J Gastroenterol. 2003;98:771–6.

    Article  PubMed  Google Scholar 

  50. Leite L, Johnston B, Barrett J, et al. Ineffective esophageal motility. The primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997;42(9):1859–65.

    Article  PubMed  CAS  Google Scholar 

  51. Simrén M, Silny J, Holloway R, et al. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut. 2003;52:784–90.

    Article  PubMed  Google Scholar 

  52. Ho SH, Chang CH, Wu Ch. Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci. 2000;47(3):652–6.

    Article  Google Scholar 

  53. Kim SH, Lee SH, Im HH, et al. The relationship between ineffective esophageal motility and gastro-esophageal reflux disease. Korean J Gastroenterol. 2005;46(4):255–61.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology and Surgery Departments, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga # 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico

    Mariel A. Mejía-Rivas, Alejandro Herrera-López, Jorge Hernández-Calleros, Miguel F. Herrera & Miguel A. Valdovinos

Authors
  1. Mariel A. Mejía-Rivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro Herrera-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Hernández-Calleros
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miguel F. Herrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miguel A. Valdovinos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miguel A. Valdovinos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mejía-Rivas, M.A., Herrera-López, A., Hernández-Calleros, J. et al. Gastroesophageal Reflux Disease in Morbid Obesity: The Effect of Roux-en-Y Gastric Bypass. OBES SURG 18, 1217–1224 (2008). https://doi.org/10.1007/s11695-008-9474-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-008-9474-2

Keywords

Search

Navigation