Gastroesophageal Reflux Disease in the Bariatric Surgery Patient

  • Paul A. Thodiyil
  • Samer G. Mattar
  • Philip R. Schauer


The increasing incidence of esophageal and gastric cardia adenocarcinoma has been paralleled by the rising prevalence o f obesity in the United States population. Risk factors for esophageal adenocarcinoma are high body mass index (BMI) (1, 2, 3, 4), gastroesophageal reflux symptoms (5,6), hiatal hernia, and esophagitis (7).


Gastric Bypass Morbid Obesity Lower Esophageal Sphincter Adjustable Gastric Banding GERD Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chow WH, et al. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1998;90:150–155.CrossRefPubMedGoogle Scholar
  2. 2.
    Lagergren J, Bergstrom R, Adami HO, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 2000;130:883–890.CrossRefGoogle Scholar
  3. 3.
    Wu AH, Wan P, Bernstein L. A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control 2001;12:721–732.CrossRefPubMedGoogle Scholar
  4. 4.
    Vaughan TL, Davis S, Kristal A, Thomas DB. Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 1995;4: 85–92.PubMedGoogle Scholar
  5. 5.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825–831.CrossRefPubMedGoogle Scholar
  6. 6.
    Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: scientific review. JAMA 2002;287:1972–1981.CrossRefPubMedGoogle Scholar
  7. 7.
    Chow WH, et al. The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 1995;274:474–477.CrossRefPubMedGoogle Scholar
  8. 8.
    Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 1994;272:205–211.CrossRefPubMedGoogle Scholar
  9. 9.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13) 1549–1555.CrossRefPubMedGoogle Scholar
  10. 10.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232:515–529.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Murray L, et al. Relationship between body mass and gastrooesophageal reflux symptoms: The Bristol Helicobacter Project. Int J Epidemiol 2003;32:645–650.CrossRefPubMedGoogle Scholar
  12. 12.
    Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 1999;106:642–649.CrossRefPubMedGoogle Scholar
  13. 13.
    Csendes A, Burdiles P, Rojas J, Burgos A, Henriquez A. [Pathological gastroesophageal reflux in patients with severe, morbid and hyper obesity]. Rev Med Chil 2001;129:1038–1043.PubMedGoogle Scholar
  14. 14.
    Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 1999;94:2840–2844.CrossRefPubMedGoogle Scholar
  15. 15.
    Wajed SA, Streets CG, Bremner CG, DeMeester TR. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg 2001;136:1014–1018; discussion 1018–1019.CrossRefPubMedGoogle Scholar
  16. 16.
    Lundell L, Ruth M, Sandberg N, Bove-Nielsen M. Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci 1995;40:1632–1635.CrossRefPubMedGoogle Scholar
  17. 17.
    Nilsson M, Lundegardh G, Carling L, Ye W, Lagergren J. Body mass and reflux oesophagitis: an oestrogen-dependent association? Scand J Gastroenterol 2002;37: 626–630.CrossRefPubMedGoogle Scholar
  18. 18.
    Lagergren J, Bergstrom R, Nyren O. No relation between body mass and gastrooesophageal reflux symptoms in a Swedish population based study. Gut 2000;47:26–29.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    DeMeester TR, Wernly JA, Bryant GH, Little AG, Skinner DB. Clinical and in vitro analysis of determinants of gastroesophageal competence. A study of the principles of antireflux surgery. Am J Surg 1979;137:39–46.CrossRefPubMedGoogle Scholar
  20. 20.
    Mercer CD, Wren SF, DaCosta LR, Beck IT. Lower esophageal sphincter pressure and gastroesophageal pressure gradients in excessively obese patients. J Med 1987;18: 135–146.PubMedGoogle Scholar
  21. 21.
    Sugerman H, Windsor A, Bessos M, Wolfe L. Intraabdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Intern Med 1997;241:71–79.CrossRefPubMedGoogle Scholar
  22. 22.
    McIntosh S, et al. Relationship of abdominal pressure and body mass index in men with LUTS. Neurourol Urodyn 2003;22:602–605.CrossRefPubMedGoogle Scholar
  23. 23.
    Sanchez NC, et al. What is normal intraabdominal pressure? Am Surg 2001;67:243–248.PubMedGoogle Scholar
  24. 24.
    Noblett KL, Jensen JK, Ostergard DR. The relationship of body mass index to intraabdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 1997;8:323–326.CrossRefPubMedGoogle Scholar
  25. 25.
    Hagen J, Deitel M, Khanna RK, Ilves R. Gastroesophageal reflux in the massively obese. Int Surg 1987;72:1–3.PubMedGoogle Scholar
  26. 26.
    Hamoui N, Hagen JA, Tamhankar AP, Anthone G, Crookes P. In: Digestive Diseases Week. New Orleans, 2004.Google Scholar
  27. 27.
    Jones MP, et al. Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol 2001;96:1711–1717.CrossRefPubMedGoogle Scholar
  28. 28.
    Fein M, et al. Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease. J Gastrointest Surg1999;3:405–410.CrossRefPubMedGoogle Scholar
  29. 29.
    Kahrilas PJ, Lin S, Chen J, Manka M. The effect of hiatus hernia on gastrooesophageal junction pressure. Gut 1999;44:476–482.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Mercer CD, Rue C, Hanelin L, Hill LD. Effect of obesity on esophageal transit. Am J Surg 1985;149:177–181.CrossRefPubMedGoogle Scholar
  31. 31.
    Frezza EE, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2002;16:1027–1031.CrossRefPubMedGoogle Scholar
  32. 32.
    American Gastroenterological Association. Medical position statement: guidelines on the use of esophageal pH recording. Gastroenterology 1996;110:1981.CrossRefGoogle Scholar
  33. 33.
    Kahrilas PJ. Will impedence testing rewrite the book on GERD? Gastroenterology 2001;120:1862–1864.CrossRefPubMedGoogle Scholar
  34. 34.
    Balaji NS, Blom D, DeMeester TR, Peters JH. Redefining gastroesophageal reflux (GER). Surg Endosc 2003;17: 1380–1385.CrossRefPubMedGoogle Scholar
  35. 35.
    Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastrooesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 2004;53:1024–1031.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Guidelines for surgical treatment of gastroesophageal reflux disease (GERD). Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Surg Endosc 1998; 12:186–188.Google Scholar
  37. 37.
    Klingman RR, Stein HJ, DeMeester TR. The current management of gastroesophageal reflux. Adv Surg 1991;24:259–291.PubMedGoogle Scholar
  38. 38.
    Kauer WK, et al. A tailored approach to antireflux surgery. JThorac Cardiovasc Surg 1995;110:141–146; discussion 146–147.CrossRefGoogle Scholar
  39. 39.
    Bremner RM, et al. The effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease. J Thorac Cardiovasc Surg 1994;107:1244–1249; discussion 1249–1250.PubMedGoogle Scholar
  40. 40.
    Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc 2001;15:986–989.CrossRefPubMedGoogle Scholar
  41. 41.
    MacLean LD, Rhode BM, Sampalis J, Forse RA. Results of the surgical treatment of obesity. Am J Surg 1993;165: 155–160; discussion 160–162.CrossRefPubMedGoogle Scholar
  42. 42.
    Hall JC, et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990;211:419–427.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Mason EE, Printen KJ, Blommers TJ, Scott DH. Gastric bypass for obesity after ten years experience. Int J Obes 1978;2:197–206.PubMedGoogle Scholar
  44. 44.
    Sugerman H, et al. Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity. Int J Obes Relat Metab Disord 1998;22:230–235.CrossRefPubMedGoogle Scholar
  45. 45.
    Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg 1997;7:479–484.CrossRefPubMedGoogle Scholar
  46. 46.
    Schauer P-R, et al. Objective evidence of persistent acid reflux after Roux-en-Y gastric bypass for morbid obesity. Digestive Disease Week Abstracts and Itinerary Planner 2003, abstract No. 2003.Google Scholar
  47. 47.
    Dixon JB, Chapman L, O’Brien P. Marked improvement in asthma after Lap-Band surgery for morbid obesity. Obes Surg 1999;9:385–389.CrossRefPubMedGoogle Scholar
  48. 48.
    Weiss HG, et al. Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg 2000;180:479–482.CrossRefPubMedGoogle Scholar
  49. 49.
    DeMaria EJ, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 2001;233:809–818.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Iovino P, et al. Abnormal esophageal acid exposure is common in morbidly obese patients and improves after a successful Lap-band system implantation. Surg Endosc 2002;16:1631–1635.CrossRefPubMedGoogle Scholar
  51. 51.
    Scopinaro N, et al. Biliopancreatic diversion. World J Surg 1998;22:936–946.CrossRefPubMedGoogle Scholar
  52. 52.
    Welch NT, et al. Effect of duodenal switch procedure on gastric acid production, intragastric pH, gastric emptying, and gastrointestinal hormones. Am J Surg 1992;163:37–44; discussion 44–45.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Paul A. Thodiyil
    • 1
  • Samer G. Mattar
    • 2
  • Philip R. Schauer
    • 3
    • 4
  1. 1.Department of SurgeryThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Clarian Bariatric CenterIndianapolisUSA
  3. 3.Lerner College of MedicineUSA
  4. 4.Advanced Laparoscopic and Bariatric Surgery, Bariatric and Metabolic InstituteThe Cleveland Clinic FoundationClevelandUSA

Personalised recommendations