Skip to main content
Erschienen in: Obesity Surgery 4/2020

06.02.2020 | Original Contributions

Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass

verfasst von: Daniel Navarini, Carlos Augusto S. Madalosso, Alexandre P. Tognon, Fernando Fornari, Fábio R. Barão, Richard R. Gurski

Erschienen in: Obesity Surgery | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity.

Methods

Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery.

Results

Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m2 vs. 42.7 ± 5.7 kg/m2; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78–40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9–52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6–44.8), and age (OR 2.0, 95%CI 1.1–3.4).

Conclusions

One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
Literatur
1.
Zurück zum Zitat Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.CrossRef Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.CrossRef
2.
Zurück zum Zitat Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.CrossRefPubMed Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.CrossRefPubMed
3.
Zurück zum Zitat Madalosso CA, Fornari F, Callegari-Jacques SM, et al. Performance of the Montreal Consensus in the diagnosis of gastroesophageal reflux disease in morbidly obese patients. Obes Surg. 2008;18:668–74.CrossRefPubMed Madalosso CA, Fornari F, Callegari-Jacques SM, et al. Performance of the Montreal Consensus in the diagnosis of gastroesophageal reflux disease in morbidly obese patients. Obes Surg. 2008;18:668–74.CrossRefPubMed
4.
Zurück zum Zitat Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients. Ann Surg. 2016;263:110–6.CrossRefPubMed Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients. Ann Surg. 2016;263:110–6.CrossRefPubMed
5.
Zurück zum Zitat Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14:751–6.CrossRefPubMed Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14:751–6.CrossRefPubMed
6.
Zurück zum Zitat Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67:1351–62.CrossRefPubMed Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67:1351–62.CrossRefPubMed
7.
Zurück zum Zitat Nelson LG, Gonzalez R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71:950–3. discussion 953-4PubMed Nelson LG, Gonzalez R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71:950–3. discussion 953-4PubMed
8.
Zurück zum Zitat Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity: a prospective study based on the Montreal Consensus. Ann Surg. 2010;251:244–8.CrossRefPubMed Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity: a prospective study based on the Montreal Consensus. Ann Surg. 2010;251:244–8.CrossRefPubMed
9.
Zurück zum Zitat Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1027–31.CrossRefPubMed Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1027–31.CrossRefPubMed
10.
Zurück zum Zitat Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.CrossRefPubMed Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.CrossRefPubMed
11.
Zurück zum Zitat Varela JE, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11:987–90.CrossRefPubMed Varela JE, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11:987–90.CrossRefPubMed
12.
Zurück zum Zitat Borbely Y, Schaffner E, Zimmermann L, et al. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc. 2019;33:789–93.CrossRefPubMed Borbely Y, Schaffner E, Zimmermann L, et al. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc. 2019;33:789–93.CrossRefPubMed
13.
Zurück zum Zitat Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.CrossRefPubMed Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.CrossRefPubMed
14.
Zurück zum Zitat Barr AC, Frelich MJ, Bosler ME, et al. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy. Surg Endosc. 2017;31:410–5.CrossRefPubMed Barr AC, Frelich MJ, Bosler ME, et al. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy. Surg Endosc. 2017;31:410–5.CrossRefPubMed
15.
Zurück zum Zitat Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg. 2014;24:1436–41.CrossRefPubMed Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg. 2014;24:1436–41.CrossRefPubMed
16.
Zurück zum Zitat Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26:710–4.CrossRefPubMed Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26:710–4.CrossRefPubMed
17.
Zurück zum Zitat Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019; Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;
18.
Zurück zum Zitat Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18:1083–8.CrossRefPubMed Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18:1083–8.CrossRefPubMed
19.
Zurück zum Zitat Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20:357–62.CrossRefPubMed Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20:357–62.CrossRefPubMed
20.
Zurück zum Zitat Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26:2449–56.CrossRefPubMed Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26:2449–56.CrossRefPubMed
21.
Zurück zum Zitat Fornari F, Gruber AC, Lopes Ade B, et al. Symptom’s questionnaire for gastroesophageal reflux disease. Arq Gastroenterol. 2004;41:263–7.CrossRefPubMed Fornari F, Gruber AC, Lopes Ade B, et al. Symptom’s questionnaire for gastroesophageal reflux disease. Arq Gastroenterol. 2004;41:263–7.CrossRefPubMed
22.
Zurück zum Zitat Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.CrossRefPubMedPubMedCentral Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Ott DJ, Gelfand DW, Chen YM, et al. Predictive relationship of hiatal hernia to reflux esophagitis. Gastrointest Radiol. 1985;10:317–20.CrossRefPubMed Ott DJ, Gelfand DW, Chen YM, et al. Predictive relationship of hiatal hernia to reflux esophagitis. Gastrointest Radiol. 1985;10:317–20.CrossRefPubMed
24.
Zurück zum Zitat Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22:601–16.CrossRefPubMedPubMedCentral Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22:601–16.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237:414–27.CrossRefPubMed Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237:414–27.CrossRefPubMed
26.
Zurück zum Zitat Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27:3092–101.CrossRefPubMed Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27:3092–101.CrossRefPubMed
27.
Zurück zum Zitat Boru CE, Greco F, Giustacchini P, et al. Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study. Langenbeck's Arch Surg. 2018;403:473–9.CrossRef Boru CE, Greco F, Giustacchini P, et al. Short-term outcomes of sleeve gastrectomy conversion to R-Y gastric bypass: multi-center retrospective study. Langenbeck's Arch Surg. 2018;403:473–9.CrossRef
28.
Zurück zum Zitat Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319:241–54.CrossRefPubMedPubMedCentral Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS Randomized Clinical Trial. JAMA. 2018;319:241–54.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.CrossRefPubMed Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390–5.CrossRefPubMed
30.
Zurück zum Zitat Galvez-Valdovinos R, Cruz-Vigo JL, Marin-Santillan E, et al. Cardiopexy with ligamentum teres in patients with hiatal hernia and previous sleeve gastrectomy: an alternative treatment for gastroesophageal reflux disease. Obes Surg. 2015;25:1539–43.CrossRefPubMed Galvez-Valdovinos R, Cruz-Vigo JL, Marin-Santillan E, et al. Cardiopexy with ligamentum teres in patients with hiatal hernia and previous sleeve gastrectomy: an alternative treatment for gastroesophageal reflux disease. Obes Surg. 2015;25:1539–43.CrossRefPubMed
31.
Zurück zum Zitat Kahrilas PJ, Wu S, Lin S, et al. Attenuation of esophageal shortening during peristalsis with hiatus hernia. Gastroenterology. 1995;109:1818–25.CrossRefPubMed Kahrilas PJ, Wu S, Lin S, et al. Attenuation of esophageal shortening during peristalsis with hiatus hernia. Gastroenterology. 1995;109:1818–25.CrossRefPubMed
32.
Zurück zum Zitat Edmundowicz SA, Clouse RE. Shortening of the esophagus in response to swallowing. Am J Phys. 1991;260:G512–6. Edmundowicz SA, Clouse RE. Shortening of the esophagus in response to swallowing. Am J Phys. 1991;260:G512–6.
33.
Zurück zum Zitat Pouderoux P, Lin S, Kahrilas PJ. Timing, propagation, coordination, and effect of esophageal shortening during peristalsis. Gastroenterology. 1997;112:1147–54.CrossRefPubMed Pouderoux P, Lin S, Kahrilas PJ. Timing, propagation, coordination, and effect of esophageal shortening during peristalsis. Gastroenterology. 1997;112:1147–54.CrossRefPubMed
34.
Zurück zum Zitat Garg H, Vigneshwaran B, Aggarwal S, et al. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients. J Minim Access Surg. 2017;13:103–8.PubMedPubMedCentral Garg H, Vigneshwaran B, Aggarwal S, et al. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients. J Minim Access Surg. 2017;13:103–8.PubMedPubMedCentral
35.
Zurück zum Zitat Mejia-Rivas MA, Herrera-Lopez A, Hernandez-Calleros J, et al. Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18:1217–24.CrossRefPubMed Mejia-Rivas MA, Herrera-Lopez A, Hernandez-Calleros J, et al. Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18:1217–24.CrossRefPubMed
36.
Zurück zum Zitat Tai CM, Lee YC, Wu MS, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19:565–70.CrossRefPubMed Tai CM, Lee YC, Wu MS, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19:565–70.CrossRefPubMed
37.
Zurück zum Zitat Johnson DA, Fennerty MB. Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology. 2004;126:660–4.CrossRefPubMed Johnson DA, Fennerty MB. Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology. 2004;126:660–4.CrossRefPubMed
38.
Zurück zum Zitat Flora Filho R, Zilberstein B. Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group. Rev Hosp Clin Fac Med Sao Paulo. 1999;54:61–7.CrossRefPubMed Flora Filho R, Zilberstein B. Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group. Rev Hosp Clin Fac Med Sao Paulo. 1999;54:61–7.CrossRefPubMed
39.
Zurück zum Zitat Wang Y, Yi XY, Gong LL, et al. The effectiveness and safety of laparoscopic sleeve gastrectomy with different sizes of bougie calibration: a systematic review and meta-analysis. Int J Surg. 2018;49:32–8.CrossRefPubMed Wang Y, Yi XY, Gong LL, et al. The effectiveness and safety of laparoscopic sleeve gastrectomy with different sizes of bougie calibration: a systematic review and meta-analysis. Int J Surg. 2018;49:32–8.CrossRefPubMed
Metadaten
Titel
Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass
verfasst von
Daniel Navarini
Carlos Augusto S. Madalosso
Alexandre P. Tognon
Fernando Fornari
Fábio R. Barão
Richard R. Gurski
Publikationsdatum
06.02.2020
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 4/2020
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04286-5

Weitere Artikel der Ausgabe 4/2020

Obesity Surgery 4/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.