Skip to main content
SpringerLink
Log in

Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass

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

Abstract

Introduction

Patients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear.

Objective

To assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB.

Methods

Retrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019.

Results

Mean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux.

Conclusion

Acid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.

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

Similar content being viewed by others

References

  1. Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg United States. 2001;11:276–80.

    Article  CAS  Google Scholar 

  2. Mahawar KK, Himpens J, Shikora SA, et al. The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified Delphi approach. Obes Surg United States. 2018;28:303–12.

    Article  Google Scholar 

  3. Chakhtoura G, Zinzindohoué F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg United States. 2008;18:1130–3.

    Article  Google Scholar 

  4. Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25:951–8.

    Article  Google Scholar 

  5. Jammu GS, Sharma R. A 7-Year Clinical Audit of 1107 Cases comparing sleeve gastrectomy, Roux-En-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg United States. 2016;26:926–32.

    Article  Google Scholar 

  6. Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28:156–63.

    Article  CAS  Google Scholar 

  7. Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg United States. 2012;22:697–703.

    Article  Google Scholar 

  8. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg United States. 2018;28:3783–94.

    Article  Google Scholar 

  9. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg. 2021:1–12.

  10. Mahawar KK, Carr WRJ, Balupuri S, et al. Controversy surrounding “mini” gastric bypass. Obes Surg United States. 2014;24:324–33.

    Article  Google Scholar 

  11. Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop (“mini”) gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg United States. 2007;3:37–41.

    Google Scholar 

  12. Poghosyan T, Caille C, Moszkowicz D, et al. Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13:988–94.

    Article  Google Scholar 

  13. Bruzzi M, Duboc H, Gronnier C, et al. Long-term evaluation of biliary reflux after experimental one-anastomosis gastric bypass in rats. Obes Surg United States. 2017;27:1119–22.

    Article  Google Scholar 

  14. M’Harzi L, Chevallier J-M, Certain A, et al. Long-term evaluation of biliary reflux on esogastric mucosae after one-anastomosis gastric bypass and esojejunostomy in rats. Obes Surg United States. 2020;30:2598–605.

    Article  Google Scholar 

  15. McQuaid KR, Laine L, Fennerty MB, et al. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther England. 2011;34:146–65.

    Article  CAS  Google Scholar 

  16. Doulami G, Triantafyllou S, Albanopoulos K, et al. Acid and nonacid gastroesophageal reflux after single anastomosis gastric bypass. An objective assessment using 24-hour multichannel intraluminal impedance-pH metry. Surg Obes Relat Dis Off J Am Soc Bariatr Surg United States. 2018;14:484–8.

    Google Scholar 

  17. Saarinen T, Pietiläinen KH, Loimaala A, et al. Bile reflux is a common finding in the gastric pouch after one anastomosis gastric bypass. Obes Surg. 2020;30:875–81.

    Article  Google Scholar 

  18. Keleidari B, Mahmoudieh M, Davarpanah Jazi AH, et al. Comparison of the bile reflux frequency in one anastomosis gastric bypass and Roux-en-Y gastric bypass: a cohort study. Obes Surg United States. 2019;29:1721–5.

    Article  Google Scholar 

  19. Kassir R, Petrucciani N, Debs T, et al. Conversion of one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for biliary reflux resistant to medical treatment: lessons learned from a retrospective series of 2780 consecutive patients undergoing OAGB. Obes Surg United States. 2020;30:2093–8.

    Article  Google Scholar 

  20. Mahawar KK. Attention to technical details is important for best outcomes with one anastomosis gastric bypass. Obes Surg. 2018;28:2920–1.

    Article  Google Scholar 

  21. Mahawar KK, Parmar C, Graham Y. One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications. Minerva Chir Italy. 2019;74:126–36.

    Google Scholar 

  22. Carbajo MA, Luque-de-León E, Jiménez JM, et al. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg. 2017;27:1153–67.

    Article  Google Scholar 

  23. Slagter N, Hopman J, Altenburg AG, et al. Applying an anti-reflux suture in the one anastomosis gastric bypass to prevent biliary reflux: a long-term observational study. Obes Surg United States. 2021;

  24. Olmi S, Oldani A, Cesana G, et al. Laparoscopic one anastomosis gastric bypass versus laparoscopic one anastomosis gastric bypass with Braun anastomosis: what’s better? J Laparoendosc Adv Surg Tech A United States. 2019;29:1469–74.

    Article  Google Scholar 

  25. Tolone S, Cristiano S, Savarino E, et al. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis Off J Am Soc Bariatr Surg United States. 2016;12:62–9.

    Google Scholar 

  26. Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg United States. 2005;15:398–404.

    Article  Google Scholar 

  27. Gordon C, Kang JY, Neild PJ, et al. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther England. 2004;20:719–32.

    Article  CAS  Google Scholar 

  28. Burgerhart JS, van de Meeberg PC, Siersema PD, et al. Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur J Gastroenterol Hepatol England. 2014;26:6–10.

    Article  CAS  Google Scholar 

  29. Parmar CD, Mahawar KK. One anastomosis (mini) gastric bypass is now an established bariatric procedure: a systematic review of 12,807 patients. Obes Surg. 2018;28:2956–67.

    Article  Google Scholar 

  30. Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: an updated meta-analysis. Obes Surg United States. 2019;29:2721–30.

    Article  Google Scholar 

  31. Ramos AC, Chevallier J-M, Mahawar K, et al. IFSO (International Federation for Surgery of Obesity and Metabolic Disorders) consensus conference statement on one-anastomosis gastric bypass (OAGB-MGB): results of a modified Delphi study. Obes Surg United States. 2020;30:1625–34.

    Article  Google Scholar 

  32. Triadafilopoulos G. Acid and bile reflux in Barrett’s esophagus: a tale of two evils. Gastroenterology United States. 2001;121:1502–6.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Université de Paris, Paris, France

    William A Nehmeh, Clement Baratte, Claire Rives-Lange, Chloe Martineau, Hortense Boullenois, Vincent Guillet, Maude Le Gall, Christophe Cellier, Claire Carette, Sebastien Czernichow, Jean-Marc Chevallier & Tigran Poghosyan

  2. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, Oncologique et Bariatrique, Hôpital Européen Georges Pompidou, Paris, France

    William A Nehmeh, Clement Baratte, Hortense Boullenois, Vincent Guillet, Jean-Marc Chevallier & Tigran Poghosyan

  3. Inserm UMRS 1149, Paris, France

    Clement Baratte, Maude Le Gall, Claire Carette & Tigran Poghosyan

  4. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France

    Claire Rives-Lange & Sebastien Czernichow

  5. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Gastro-Entero-Hépatologie, Hôpital Européen Georges Pompidou, Paris, France

    Chloe Martineau & Christophe Cellier

  6. Department of Digestive Surgery, Royal Derby Hospital, Derby, UK

    Sylvia Krivan

  7. Information sciences to support personalized medicine, INSERM, Cordeliers Research Center, Paris, France

    Sebastien Czernichow

Authors
  1. William A Nehmeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clement Baratte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claire Rives-Lange
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chloe Martineau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hortense Boullenois
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sylvia Krivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vincent Guillet
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maude Le Gall
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christophe Cellier
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Claire Carette
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sebastien Czernichow
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jean-Marc Chevallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tigran Poghosyan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tigran Poghosyan.

Ethics declarations

Ethics Approval

For this type of study formal consent is not required.

Consent to Participate

Informed consent does not apply.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

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

Key Points

1. Acid reflux seems to be common in patients presenting with GERD after OAGB.

2. Impedance pH monitoring is important to determine the type of revisional procedure.

3. In case of postoperative acid reflux, revision to regular Roux-en-Y gastric bypass (RYGB) seems suitable.

4. In case of postoperative biliary reflux, revision to diverted OAGB could be performed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nehmeh, W.A., Baratte, C., Rives-Lange, C. et al. Acid Reflux Is Common in Patients With Gastroesophageal Reflux Disease After One-Anastomosis Gastric Bypass. OBES SURG 31, 4717–4723 (2021). https://doi.org/10.1007/s11695-021-05542-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-021-05542-3

Keywords

Search

Navigation