nach oben

Erschienen in:

12.11.2019 | SAGES White Paper

Surgical management of gastroesophageal reflux disease in the obese patient

verfasst von: P. Nau, H. T. Jackson, A. Aryaie, A. Ibele, D. Shouhed, E. Lo Menzo, M. Kurian, L. Khaitan, SAGES Foregut Task Force White Paper

Erschienen in: Surgical Endoscopy | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm.

Methods

A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics.

Results

It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed.

Conclusions

Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data.

Camilleri M, Dubois D, Coulie B et al (2005) Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US upper gastrointestinal study. Clin Gastroenterol Hepatol 3(6):543–552PubMed

El-Serag HB (2007) Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 5(1):17–26PubMed

Kulig M, Leodolter A, Vieth M et al (2003) Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease: an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 18(8):767–776PubMed

Hales C, Carroll, Fryar C, Ogden C (2015) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, No. 288, October 2017

Cawley J, Meyerhoefer C (2012) The medical care costs of obesity: an instrumental variables approach. J Health Econ 31(1):219–230PubMed

Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates: amid calls for health reform, real cost savings are more likely to be achieved through reducing obesity and related risk factors. Health Aff 28(Suppl1):w822–w831

El-Serag H (2008) The association between obesity and GERD: a review of the epidemiological evidence. Dig Dis Sci 53(9):2307–2312. https://doi.org/10.1007/s10620-008-0413-9 CrossRefPubMedPubMedCentral

El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005) Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 100:1243. https://doi.org/10.1111/j.1572-0241.2005.41703.x CrossRefPubMed

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG (2007) Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg 11(3):286–290. https://doi.org/10.1007/s11605-007-0097-z CrossRefPubMed

10.

Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354(22):2340–2348PubMedPubMedCentral

11.

Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143(3):199–211PubMed

12.

Crowell MD, Bradley A, Hansel S, Dionisio P, Kim HJ, Decker GA, Sharma VK (2009) Obesity is associated with increased 48-h esophageal acid exposure in patients with symptomatic gastroesophageal reflux. Am J Gastroenterol 104(3):553–559. https://doi.org/10.1038/ajg.2009.5 CrossRefPubMed

13.

Anand G, Katz PO (2008) Gastroesophageal reflux disease and obesity. Rev Gastroenterol Disord 8(4):233–239PubMed

14.

Jung HS, Choi MG, Baeg MK, Lim CH, Kim JS, Cho YK et al (2013) Obesity is associated with increasing esophageal acid exposure in korean patients with gastroesophageal reflux disease symptoms. J Neurogastroenterol Motil 19(3):338–343. https://doi.org/10.5056/jnm.2013.19.3.338 CrossRefPubMedPubMedCentral

15.

Kouklakis G, Moschos J, Kountouras J, Mpoumponaris A, Molyvas E, Minopoulos G (2005) Relationship between obesity and gastroesophageal reflux disease as recorded by 3-hour esophageal pH monitoring. Rom J Gastroenterol 14(2):117–121PubMed

16.

Hoyo C, Cook MB, Kamangar F, Freedman ND, Whiteman DC, Bernstein L et al (2012) Body mass index in relation to oesophageal and oesophagogastric junction adenocarcinomas: a pooled analysis from the International BEACON Consortium. Int J Epidemiol 41(6):1706–1718. https://doi.org/10.1093/ije/dys176 CrossRefPubMedPubMedCentral

17.

Wu JC, Mui LM, Cheung CM, Chan Y, Sung JJ (2007) Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology 132(3):883–889. https://doi.org/10.1053/j.gastro.2006.12.032 CrossRefPubMed

18.

Stene-Larsen G, Weberg R, Froyshov Larsen I, Bjortuft O, Hoel B, Berstad A (1988) Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol 23(4):427–432PubMed

19.

Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94(10):2840–2844PubMed

20.

Stefanidis D, Hope WW, Kohn GP et al (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669PubMed

21.

Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 108(3):308–328 (Quiz 329) PubMed

22.

Schietroma M, Piccione F, Clementi M, Cecilia EM, Sista F, Pessia B, Carlei F, Guadagni S, Amicucci G (2017) Short- and long-term, 11–22 years, results after laparoscopic nissen fundoplication in obese versus nonobese patients. J Obes 2017:7589408PubMedPubMedCentral

23.

Frezza EE, Ikramuddin S, Gourash W et al (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 16(7):1027–1031PubMed

24.

Nelson LGGR, Haines K, Gallagher SF, Murr MM (2005) Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg 71:950–953PubMed

25.

Madalosso CAS, Gurski RR, Callegari-Jacques SM, Navarini D, Mazzini G, Pereira MDS (2016) The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients. Ann Surg 263(1):110–116PubMed

26.

Mejía-Rivas MAH, Hernández-Calleros J, Herrera MF, Valdovinos MA (2008) Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg 18:1217–1224PubMed

27.

Farmer AD, Ruffle JK, Aziz Q (2017) The role of esophageal hypersensitivity in functional esophageal disorders. J Clin Gastroenterol 51(2):91–99PubMed

28.

Anderson SH, Yadegarfar G, Arastu MH, Anggiansah R, Anggiansah A (2006) The relationship between gastro-oesophageal reflux symptoms and achalasia. Eur J Gastroenterol Hepatol 18(4):369–374PubMed

29.

Patterson EJ, Davis DG, Khajanchee Y, Swanström LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17(10):1561–1565PubMed

30.

Perez ARMA, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15:986–989PubMed

31.

LE Morgenthal CB, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21:1978–1984PubMed

32.

Prachand VN, Alverdy JC (2010) Gastroesophageal reflux disease and severe obesity: fundoplication or bariatric surgery? World J Gastroenterol 16:3757–3761PubMedPubMedCentral

33.

Kavanagh R, Smith J, Bashir U, Jones D, Avgenakis E, Nau P (2019) Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease. Surg Endosc. https://doi.org/10.1007/s00464-019-06934-4 CrossRefPubMed

34.

Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285(18):2331–2338PubMed

35.

Varela JE, Hinojosa MW, Nguyen NT (2009) Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis 5(2):139–143PubMed

36.

Raftopoulos IAO, Courcoulas AP, Luketich JD (2004) Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg 14:1373–1380PubMed

37.

Ibele AGM, Gould J (2012) The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation. Surg Endosc 26:177–181PubMed

38.

Kellogg TA, Andrade R, Maddaus M, Slusarek B, Buchwald H, Ikramuddin S (2007) Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3(1):52–57 (Discussion 58–59) PubMed

39.

Nadaleto BFHF, Patti MG (2016) Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery 159:475–486PubMed

40.

LE Braghetto I, Korn O, Valladares H, Molina JC, Henriquez A (2010) Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 20:357–362PubMed

41.

Daes JJM, Said N, Daza JC, Dennis R (2012) Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg 22:1874–1879PubMedPubMedCentral

42.

Keidar AAL, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20:140–147PubMed

43.

LA Melissas J, Klinaki I, Perisinakis K, Koukouraki S, de Bree E, Karkavitsas N (2013) Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg 258:976–982PubMed

44.

Alhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Kalantar Motamedi SM, Rahim S, Patel I, Aryaie A, Abbas M, Rogula T, Khaitan L (2018) Does sleeve shape make a difference in outcomes? Obes Surg 28(6):1731–1737PubMed

45.

Del Genio GTS, Limongelli P, Brusciano L, D’Alessandro A, Docimo G, Rossetti G, Silecchia G, Iannelli A, del Genio A, del Genio F, Docimo L (2014) Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg 24:71–77PubMed

46.

Burgerhart JSSC, Schoon EJ, Smulders JF, van de Meeberg PC, Siersema PD, Smout AJ (2014) Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg 24:1436–1441PubMed

47.

Felsenreich DMKR, Schermann M, Beckerhinn P, Kristo I, Krebs M, Prager G, Langer FB (2017) Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg 27:3092–3101PubMed

48.

Genco ASE, Casella G, Maselli R, Castagneto-Gissey L, Di Lorenzo N, Basso N (2017) Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 13:568–574PubMed

49.

DuPree CEBK, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149:328–334PubMed

50.

Sheppard CESD, de Gara CJ, Karmali S, Birch DW (2015) Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg 25:763–768PubMed

51.

Pagé MP, Kastenmeier A, Goldblatt M, Frelich M, Bosler M, Wallace J, Gould J (2014) Medically refractory gastroesophageal reflux disease in the obese: what is the best surgical approach? Surg Endosc 28(5):1500–1504PubMed

52.

Nadaleto BF, Herbella FA, Patti MG (2016) Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery 159(2):475–486PubMed

53.

Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P, Bueter M (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319(3):255–265. https://doi.org/10.1001/jama.2017.20897 CrossRefPubMedPubMedCentral

54.

Oelschlager BK, Pellegrini CA, Hunter JG et al (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213(4):461–468PubMed

55.

Mahawar KK, Carr WR, Jennings N, Balupuri S, Small PK (2015) Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg 25(1):159–166PubMed

56.

Olmi S, Caruso F, Uccelli M, Cioffi S, Ciccarese F, Cesana G (2017) Laparoscopic sleeve gastrectomy combined with Rossetti fundoplication (R-Sleeve) for treatment of morbid obesity and gastroesophageal reflux. Surg Obes Relat Dis 13(12):1945–1950PubMed

57.

Hawasli A, Reyes M, Hare B, Meguid A, Harriott A, Almahmeed T, Thatimatla N, Szpunar S (2016) Can morbidly obese patients with reflux be offered laparoscopic sleeve gastrectomy? A case report of 40 patients. Am J Surg 211(3):571–576PubMed

58.

Lasnibat JP, Braghetto I, Gutierrez L, Sanchez F (2017) Sleeve gastrectomy and fundoplication as a single procedure in patients with obesity and gastroesophageal reflux. Arq Bras Cir Dig 30(3):216–221PubMedPubMedCentral

59.

Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M (2017) Gastroesophageal reflux disease and morbid obesity: to sleeve or not to sleeve? World J Gastroenterol 23(13):2269–2275PubMedPubMedCentral

60.

Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M (2014) Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 260(5):909–915PubMed

61.

Stenard F, Iannelli A (2015) Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol 21(36):10348–10357PubMedPubMedCentral

62.

Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ (2016) Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 211(1):250–267PubMed

63.

Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Crookes PF (2009) Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 13(8):1440–1447PubMedPubMedCentral

64.

Goitein D, Sakran N, Rayman S, Szold A, Goitein O, Raziel A (2017) Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy. Surg Obes Relat Dis 13(2):138–142PubMed

65.

Ghassemian AJ, MacDonald KG, Cunningham PG, Swanson M, Brown BM, Morris PG et al (1997) The workup for bariatric surgery does not require a routine upper gastrointestinal series. Obes Surg 7(1):16–18PubMed

66.

Schirmer B, Erenoglu C, Miller A (2002) Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 12(5):634–638PubMed

67.

Saarinen T, Kettunen U, Pietiläinen KH, Juuti A (2018) Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis 14(6):757–762PubMed

68.

Telem DA, Gould J, Pesta C et al (2017) American society for metabolic and bariatric surgery: care pathway for laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 13(5):742–749PubMed

69.

Küper MA, Kratt T, Kramer KM, Zdichavsky M, Schneider JH, Glatzle J, Stüker D, Königsrainer A, Brücher BL (2010) Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery. Surg Endosc 24(8):1996–2001PubMed

70.

Bradley DD, Louie BE, Chen J, Aye RW, McMahon R, Farivar AS (2015) The effect of concurrent esophageal pathology on bariatric surgical planning. J Gastrointest Surg 19(1):111–115 (Discussion 115–116) PubMed

Titel: Surgical management of gastroesophageal reflux disease in the obese patient
verfasst von: P. Nau
H. T. Jackson
A. Aryaie
A. Ibele
D. Shouhed
E. Lo Menzo
M. Kurian
L. Khaitan
SAGES Foregut Task Force White Paper
Publikationsdatum: 12.11.2019
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 1/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07231-w

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

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

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

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

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar 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

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

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

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

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2020

Real-time augmented fluoroscopy-guided lung marking for thoracoscopic resection of small pulmonary nodules

Disease burden of appendectomy for appendicitis: a population-based cohort study

Laparoscopic subtotal colectomy with double-end ileosigmoidostomy in right iliac fossa facilitates second-stage surgery in patients with inflammatory bowel disease

Feasibility and safety of laparoscopy-assisted distal gastrectomy performed by trainees supervised by an experienced qualified surgeon

The clinical application of mental nerve dissection in transoral endoscopic thyroidectomy via an oral vestibular approach

S122: impact of fluorescence and 3D images to completeness of lateral pelvic node dissection

Update Chirurgie