Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function
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Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass.
Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance–manometry, and modified “timed barium swallow” before/after surgery.
Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p < 0.05). The percentage of swallows with normal bolus transit increased following transformation from gastric band to gastric bypass (57.9 ± 4.1 and 83.6 ± 3.4 %, respectively, p < 0.01).
From an esophageal perspective, gastric bypass surgery induces less motility disorders and esophageal symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.
KeywordsBariatric surgery Impedance–manometry Endoscopy Obesity
Body mass index
Bolus transit time
Distal esophageal amplitude
Esophageal function testing
Gastroesophageal reflux disease
Los Angeles classification
Laparoscopic adjustable silicone gastric banding
Lower esophageal sphincter
Laparoscopic Roux-en-Y gastric bypass
Laparoscopic vertical banded gastroplasty
Proton pump inhibitors
We like to specifically acknowledge the hard work of our study nurse Patrizia Künzler with regard to patient and data management.
This study was funded by the Research Council of the University of Zurich and registered at ClinicalTrials.gov (NCT00680030).
Jan Borovicka and Radu Tutuian equally contributed to the study design, planned the study protocol. Both of them also performed data analysis and wrote the manuscript. Radu Tutuian obtained funding from the study from the Research Foundation of the University Hospital of Zurich/University of Zurich. Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, and Philipp Bisang performed the procedures and analyzed the data. Martin Thurnheer performed all gastric bypass surgeries. Bernd Schultes and Jean-Pierre Gutzwiler performed data analysis and approved the final draft. Daniel Pohl wrote the study protocol. Michael Fried and Christa Meyenberger critically reviewed the analysis and approved the final draft. All authors have read and approved the final version of the manuscript.
Compliance with ethical standards
Radu Tutuian contributes to educational programs of Sandhill Scientific Inc. and Medical Measurements Systems (MMS) International. Travel support and speaker honoraria were received from Allmiral, AbbVie, Abbott, UCB in the past 2 years. Jan Borovicka, Claudia Krieger-Gruebel, Boudewijn van der Weg, Michael Christian Sulz, Philipp Bisang, Martin Thurnheer, Bernd Schultes, Jean-Pierre Gutzwiler, Daniel Pohl, Michael Fried, and Christa Meyenberger have no conflicts of interests that are relevant to the manuscript.
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