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Obesity Surgery

, Volume 30, Issue 1, pp 161–168 | Cite as

Esophagitis After Bariatric Surgery: Large Cross-sectional Assessment of an Endoscopic Database

  • Reem Matar
  • Daniel Maselli
  • Eric Vargas
  • Jaruvongvanich Veeravich
  • Fateh Bazerbachi
  • Azizullah Beran
  • Andrew C. Storm
  • Todd Kellogg
  • Barham K. Abu DayyehEmail author
Original Contributions

Abstract

Introduction

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are common bariatric surgeries that can alter physiological barriers against gastroesophageal reflux disease (GERD). We investigated the prevalence and potential physiologic underpinnings of erosive esophagitis (EE) after bariatric surgery in a large cohort with long-term follow-up.

Methods

This is a retrospective analysis of 517 patients who underwent an esophagogastroduodenoscopy after SG or RYGB. A matched case-control sub-study was conducted to compare physiologic contributors of GERD after SG with a pre-operative cohort using high-resolution manometry.

Results

Consecutive post-SG and post-RYGB patients (body mass index (BMI) 34 ± 9.1 kg/m2, age 49 ± 12.4 years, 83% female) were included. EE was more prevalent after SG than RYGB (37.9% vs. 17.6%, p = 0.0001), including severe EE (10.7% vs. 3.1%, p = 0.0007). Post-SG EE remained more prevalent after adjusting for multiple confounders (OR = 2.47, p = 0.0012). In a matched case-control analysis, prevalence of EE was 31% in 39 SG patients compared with 13% in 40 pre-bariatric surgery patients with GERD and obesity (p = 0.044). Significant physiologic changes conducive to GERD was observed after SG including (1) decrease resting lower esophageal sphincter (LES) (mmHg) pressure (21.3 ± 14.1 vs. 39.8 ± 35.6, p = 0.004), and (2) lower maximal distal contractile integral (DCI) (mmHg-s-cm) (3814.8 ± 2684.8 vs. 5111.8 ± 7713, p = 0.034).

Conclusion

EE is more prevalent after SG compared with RYGB in a pre-bariatric surgery cohort with GERD. SG is associated with significant esophageal physiologic changes conducive to GERD and its clinical consequences.

Keywords

GERD Bariatric surgery Erosive esophagitis Sleeve gastrectomy Roux-en-Y gastric bypass PPI Hiatal hernia 

Notes

Compliance with Ethical Standards

Conflict of Interest

Barham K. Abu Dayyeh reports personal fees from USGI Medical, grants from Apollo Endosurgery, personal fees from Johnson and Johnson, personal fees from Olympus, grants and personal fees from Boston Scientific, during the conduct of the study. Other authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by institutional IRB.

Informed Consent

For this type of study, formal consent was not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Reem Matar
    • 1
  • Daniel Maselli
    • 1
  • Eric Vargas
    • 1
  • Jaruvongvanich Veeravich
    • 1
  • Fateh Bazerbachi
    • 1
  • Azizullah Beran
    • 1
  • Andrew C. Storm
    • 1
  • Todd Kellogg
    • 2
  • Barham K. Abu Dayyeh
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyMayo Clinic School of MedicineRochesterUSA
  2. 2.Division of SurgeryMayo ClinicRochesterUSA

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