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

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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.

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Author information

Correspondence to Carlos Augusto S. Madalosso.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement and Consent Statement

The Ethical Committee of the University of Passo Fundo (RS, Brazil) approved this study (number 46976715.5.0000.5342) in accordance with the Helsinki declaration and Brazilian federal regulation. This study is registered at ClinicalTrials.gov under the record number NCT03692455. Informed consent was obtained from all individual participants included in the study.

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Navarini, D., Madalosso, C.A.S., Tognon, A.P. et al. Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass. OBES SURG (2020). https://doi.org/10.1007/s11695-019-04286-5

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Keywords

  • Bariatric surgery
  • GERD
  • Laparoscopic Roux-en-Y gastric bypass
  • Laparoscopic sleeve gastrectomy
  • Obesity