Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: Review of the Bariatric Outcomes Longitudinal Database

doi:10.1016/j.soard.2013.07.018

Surgery for Obesity and Related Diseases

Volume 10, Issue 3, May–June 2014, Pages 502-507

https://doi.org/10.1016/j.soard.2013.07.018 Get rights and content

Abstract

Background

The prevalence of gastroesophageal reflux disease (GERD) in the morbidly obese population is as high as 45%. The objective of this study was to compare the efficacy of various bariatric procedures in the improvement of GERD.

Methods

The Bariatric Outcomes Longitudinal Database is a prospective database of patients who undergo bariatric surgery by a participant in the American Society of Metabolic and Bariatric Surgery Center of Excellence program. GERD is graded on a 6-point scale, from 0 (no history of GERD) to 5 (prior surgery for GERD). Patients with GERD severe enough to require medications (grades 2, 3, and 4) from June 2007 to December 2009 are identified; the resolution of GERD is noted based on 6-month follow-up.

Results

Of a total of 116,136 patients, 36,938 patients had evidence of GERD preoperatively. After excluding patients undergoing concomitant hiatal hernia repair or fundoplication, there were 22,870 patients with 6-month follow-up. Mean age was 47.6±11.1 years, with an 82% female population. Mean BMI was 46.3±8.0 kg/m². Mean preoperative GERD score for patients with Roux-en-Y gastric bypass (RYGB) was 2.80±.56, and mean postoperative score was 1.33±1.41 (P<.0001). Similarly, adjustable gastric banding (AGB, 2.77±.57 to 1.63±1.37, P<.0001) and sleeve gastrectomy (SG, 2.82±.57 to 1.85±1.40, P<.0001) had significant improvement in GERD score. GERD score improvement was best in RYGB patients (56.5%; 7955 of 14,078) followed by AGB (46%; 3773 of 8207) and SG patients (41%; 240 of 585).

Conclusion

All common bariatric procedures improve GERD. Roux-en-Y gastric bypass is superior to adjustable gastric banding and sleeve gastrectomy in improving GERD. Also, the greater the loss in excess weight, the greater the improvement in GERD score.

Section snippets

Database

BOLD is a proprietary, Internet-based software product developed by the Surgical Review Corporation (SRC) to collect prospective data for all bariatric surgery patients treated by American Society for Metabolic and Bariatric Surgery BSCOE participants for the purpose of assessing outcomes and quality of care. Data entry started in June 2007, and all BSCOE participants have been required to enter patient data into BOLD since January 2008. The participants enter preoperative, intraoperative, and

Results

A total of 116,136 patients underwent bariatric surgery from June 2007 to December 2009. Of these, 36,938 patients had preoperative evidence of GERD severe enough to require medications. After excluding patients undergoing concomitant hiatal hernia repair or fundoplication, there were 31,642 patients. Of these, 22,870 (72.3%) patients had a 6-month follow-up recording the outcome of GERD.

Demographic characteristics of these patients are shown in Table 2. Predominantly more patients had RYGB

Discussion

Roux-en-Y gastric bypass has been shown to be associated with significant improvement in GERD, which is corroborated by our study. AGB is also associated with improvement in GERD in 46.5% patients. Although this is significantly less than RYGB, it does represent improvement in up to half the patients undergoing AGB. Similarly, sleeve gastrectomy (SG) is associated with 41.7% improvement in GERD. This represents a fairly good number of patients overall.

AGB has been implicated with both

Conclusions

All common bariatric procedures improve GERD. Roux-en-Y gastric bypass is superior to adjustable gastric banding and sleeve gastrectomy in improving GERD. Improvement in GERD is also a function of weight loss, because patients with higher weight loss experience significantly higher improvement in GERD.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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^☆: Presented as a poster of distinction at the 29th American Society of Metabolic and Bariatric Surgery Meeting, San Diego, California, June 2012.

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Original articleImprovement in gastroesophageal reflux disease symptoms after various bariatric procedures: Review of the Bariatric Outcomes Longitudinal Database☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Database

Results

Discussion

Conclusions

Disclosures

Gastroenterology

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

J Gastrointest Surg

Prevalence of obesity in the United States, 2009–2010

NCHS data brief, no 82

NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis

Ann Intern Med

Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux disease

Aliment Pharmacol Ther

Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery?

World J Gastroenterol

Original article
Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: Review of the Bariatric Outcomes Longitudinal Database☆