Abstract
Obesity increases the risk of various weight-related disorders, including esophageal reflux disease. In this chapter, we complete a focused review of GERD before and after bariatric surgery. We will discuss the prevalence and pathophysiology of reflux in bariatric surgery patients. The rationale and management of reflux before bariatric surgery will also be addressed including surgical options such as fundoplication and the various bariatric surgery procedures that can improve reflux disease. Finally, we will discuss anti-reflux treatment options after weight loss surgery, in particular conversion from sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), placement of LINX, as well as fundoplication after sleeve gastrectomy and RYGB.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Prachand VN, Alverdy JC. Gastroesophageal reflux disease and severe obesity: fundoplication or bariatric surgery? World J Gastroenterol. 2010;16:757–61.
Khan A, Kim A, Sanossian C, Francois F. Impact of obesity treatment on gastroesophageal reflux disease. World J Gastroenterol. 2016;22(4):1627–38.
Devendran N, Chauhan N, Armstrong D, Upton A, Kamath M. GERD and obesity: is the autonomic nervous system the missing link? Crit Rev Biomed Eng. 2014;42(1):17–24.
Hong D, Khajanchee YS, Pereira N, Lockhart B, Patterson E, Swanstrom LL. Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese. Obes Surg. 2004;14:744–9.
El-Sarag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.
Heimgartner B, Herzig M, Borbély Y, Kröll D, Nett P, Tutuian R. Symptoms, endoscopic findings and reflux monitoring results in candidates for bariatric surgery. Dig Liver Dis. 2017;49(7):750–6.
Friedenberg F, Xanthopoulos M, Foster G, Richter J. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111–22.
Jacobson B, Somers S, Fuchs C, Kelly C, Camargo C. Association between body mass index and gastroesophageal reflux symptoms in both normal weight and overweight women. N Engl J Med. 2006;354(22):2340–8.
Song J, Chung S, Lee J, Kim Y, Chang D, Son H, Kim J, Rhee J, Rhee P. Relationship between gastroesophageal reflux symptoms and dietary factors in Korea. J Neurogastroenterol Motil. 2011;17:54–60.
Himpens J, Dapri G, Cadière G. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.
Lyon A, Gibson SC, De-loyde K, Martin D. Gastroesophageal reflux in laparoscopic sleeve gastrectomy: hiatal findings and their management influence outcome. Surg Obes Relat Dis. 2015;11:530–8.
Altieri MS, Pryor AD. Gastroesophageal reflux disease after bariatric procedures. Surg Clin N Am. 2015;95:579–91.
De Jong JR, Van Ramshorst B, Timmer R, Gooszen HG, Smouth AJ. The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux. Obes Surg. 2004;14(3):399–406.
Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity; the effect of lap-band placement. Obes Surg. 1999;9(6):527–31.
Weiss H, Nehoda H, Labeck B, Peer-Kühberger M, Klingler P, Gadenstätter M, Aigner F, Wetscher G. Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility. Am J Surg. 2000;180(6):479–82.
Ardila-Hani A, Soffer EE. Review article: the impact of bariatric surgery on gastrointestinal motility. Aliment Pharmacol Ther. 2011;34(8):825–31.
Abdelkader NA, Montasser IF, Bioumy EE, Saad WE. Impact of anthropometric measures and serum leptin on severity of gastroesophageal reflux disease. Dis Esophagus. 2015;28:691–8.
Parmar CD, Mahawar KK, Boyle M, Schroeder N, Balupuri S, Small PK. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss. Obes Surg. 2017;27(7):1651–8.
Stefanidis D, Navarro F, Augenstein VA, Gersin KS, Heniford BT. Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc. 2012;26(12):3521–7.
Yates RB, Oelschlager BK, Pellegrini CA. Chapter 42, Gastroesophageal reflux disease and hiatal hernia. In: Sabiston textbook of surgery. 20th ed. Philadelphia: Elsevier; 2017. p. 1043–64.
Holloway RH, Wyman JB, Dent J. Failure of transient lower esophageal sphincter relaxation in response to gastric distention in patients with achalasia; evidence for neural mediation of transient lower esophageal sphincter relaxations. Gut. 1989;30(6):762–7.
Pehl C, Pfeiffer A, Waizenhoefer A, Wendl B, Schepp W. Effect of caloric density of a meal on lower oesophageal sphincter motility and gastro-esophageal reflux in healthy subjects. Aliment Pharmacol Ther. 2001;15(2):233–9.
JC W, Mui LM, Cheung CM, Chan Y, Sung JJ. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132(3):883–9.
Piche T, desVarannes SB, Sacher-Huvelin S, Holst JJ, Cuber JC, Galmiche JP. Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. Gastroenterology. 2003;124(4):894–902.
Yancy WS, Provenzale D, Westman EC. Improvement of gastroesophageal reflux disease after initiation of a low-carbohydrate diet: five brief case reports. Altern Ther Health Med. 2001;7(6):120, 116–9.
DuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease. JAMA Surg. 2014;149(4):328–34.
Howard D, Caban A, Cendan J, Ben-David K. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.
Tai CM, Huang CK, Lee YC, Chang CY, Lee CT, Lin JT. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc. 2013;27(4):1260–6.
Melissas J, Leventi A, Klinaki I, Perisinakis K, Koukouraki S, de Bree E, Karkavitsas N. Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg. 2013;258:976–82.
Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL. Comparison of objective outcomes following laparoscopic Nissen fundoplication vs laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc. 2003;17:1561–5.
Anvari M, Bamehriz F. Outcome of laparoscopic Nissen fundoplication in patients with body mass index > or = 35. Surg Endosc. 2006;20:230–4.
Chisholm JA, Jamieson GG, Lally CJ, Devitt PG, Game PA, Watson DI. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg. 2009;13:1064–70.
D’Alessio MJ, Arnaoutakis D, Giarelli N, Villadolid DV, Rosemurgy AS. Obesity is not a contraindication to laparoscopic Nissen fundoplication. J Gastrointest Surg. 2005;9:949–54.
Winslow ER, Frisella MM, Soper NJ, Klingensmith ME. Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surg Endosc. 2003;17:2003–11.
Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.
Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007;21:1978–84.
Treitl D, Nieber D, Ben-David K. Operative treatments for reflux after bariatric surgery: current and emerging management options. J Gastrointest Surg. 2017;21:577–82.
Papavramidis T, Grosomanidis V, Papakostas P, Penna S, Kotzampassi K. Intragastric balloon fundal or antral position affects weight loss and tolerability. Obes Surg. 2012;22:904–9.
Pallati PK, Shaligram A, Shostrom VK, Oleynikov D, McBride CL, Goede MR. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2014;10:502–7.
Reavis KM. Management of the obese patient with gastroesophageal reflux disease. Thorac Surg Clin. 2011;21(4):489–98.
De Jong JR, Tiethof C, van Ramshorst B, et al. Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed. Surg Endosc. 2009;23(12):2802–8.
Chiu S, Birch D, Shi X, Sharma A, Karmali S. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7:510–5.
Hawasli A, Reyes M, Hare B, Meguid A, Harriott A, Almahmeed T, Thatimatla N, Szpunar S. Can morbidly obese patients with reflux be offered laparoscopic sleeve gastrectomy? A case report of 40 patients. Am J Surg. 2016;211:571–6.
Sharma A, Aggarwal S, Ahuja V, Bal C. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10:600–6.
Gorodner V, Buxhoeveden R, Clemente G, Sole L, Caro L, Grigaites A. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease: preliminary results. Surg Endosc. 2015;29:1760–8.
Mandeville Y, Van Looveren R, Vancoillie P, Verbeke X, Vandendriessche K, Vuylsteke P, Pattyn P, Smet B. Moderating the enthusiasm of sleeve gastrectomy: up to fifty percent of reflux symptoms after ten years in a consecutive series of one hundred laparoscopic sleeve gastrectomies. Obes Surg. 2017;27(7):1797–803.
Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A. Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort. Surg Obes Relat Dis. 2017;13(6):951–9.
Genco A, Soricelli E, Casella G, Maseli R, Castagneto-Gissey L, Di Lorenzo N, Basso N. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.
Daes J, Jimenez M, Said N, Daza J, Dennis R. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg. 2012;22:1874–9.
Moon RC, Teixeira AF, Jawad MA. Safety and effectiveness of anterior fundoplication sleeve gastrectomy in patients with severe reflux. Surg Obes Relat Dis. 2017;13:547–52.
Nocca D, Skalli EM, Boulay E, Nedelcu M, Fabre JM, Loureiro M. Nissen sleeve (N-sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis. 2016;12:1832–7.
Frezza E, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1027–31.
Peterli R, Wolnerhanssen B, Vetter D, Nett P, Gass M, Borbely Y, Peters T, Schiesser M, Schultes B, Beglinger C, Drewe J, Bueter M. Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity—3-year outcomes of the prospective randomized Swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg. 2017;265(3):466–73.
Schauer P, Ikramuddin S, Gourash W, Ramesh R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.
Sudan R, Maciejewski M, Wilk A, Nguyen N, Ponce J, Morton J. Comparative effectiveness of primary bariatric operations in the United States. Surg Obes Relat Dis. 2017;13(5):826–34.
Csendes A, Burgos AM, Smok G, Burdiles P, Henriquez A. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10(2):259–64.
Gorodner V, Buxhoeveden R, Clemente G, Sanchez C, Caro L, Grigaites A. Barrett’s esophagus after Roux-en-Y gastric bypass: does regression occur? Surg Endosc. 2017;31:1849–54.
Mion F, Tolone S, Garros A, Savarino E, Pelascini E, Robert M, Poncet G, Valette PJ, Marjoux S, Docimo L, Roman S. High-resolution impedence manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26:2449–56.
Aarts E, Dogan K, Koehestanie P, Aufenacker T, Janssen I, Berends F. Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Surg Obes Relat Dis. 2014;10:633–40.
Patel S, Eckstein J, Acholonu E, Abu-Jaish W, Szomstein S, Rosenthal R. Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis. 2010;6:391–8.
Bonavina L, et al. Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: one- and 2-year results of a feasibility trial. Ann Surg. 2010;252(5):857–62.
Desart K, Rossidis G, Michel M, Lux T, Ben-David K. Gastroesophageal reflux management with the LINX system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. J Gastrointest Surg. 2015;19:1782–6.
Carmeli I, Golomb I, Sadot E, Kashtan H, Keidar A. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015;11:79–87.
Homan J, Betzel B, Aarts E, van Laarhoven K, Janssen I, Berends F. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2015;11:771–8.
Poghosyan T, Lazzati A, Moszkowicz D, Danoussou D, Vychnevskaia K, Azoulay D, Czernichow S, Carette C, Bouillot J. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients. Surg Obes Relat Dis. 2016;12:1646–54.
AlSabah S, Alsharqawi N, Almulla A, Akrof S, Alenezi K, Buhaimed W, Al-Subaie S, Al Haddad M. Approach to poor weight loss after laparoscopic sleeve gastrectomy: re-sleeve vs. gastric bypass. Obes Surg. 2016;26:2302–7.
Noel P, Nedelcu M, Eddbali I, Manos T, Gagner M. What are the long-term results 8 years after sleeve gastrectomy? Surg Obes Relat Dis. 2017;13(7):1110–5.
Mattar S, Qureshi F, Taylor D, Schauer P. Treatment of refractory gastroesophageal reflux disease with radiofrequency energy (Stretta) in patients after Roux-en-Y gastric bypass. Surg Endosc. 2006;20:850–4.
Hawasli A, Phillips A, Tarboush M. Laparoscopic management of reflux after Roux-en-Y gastric bypass using the LINX system and repair of hiatal hernia: a case report. Surg Obes Relat Dis. 2016;12:e51–4.
Munoz-Largacha J, Hess D, Litle V, Fernando H. Lower esophageal magnetic sphincter augmentation for persistent reflux after Roux-en-Y gastric bypass. Obes Surg. 2016;26:464–6.
Chen R, Lautz D, Gilbert R, Bueno R. Antireflux operation for gastroesophageal reflux after Roux-en-Y gastric bypass for obesity. Ann Thorac Surg. 2005;80:1938–40.
Kawahara NT, Alster C, Maluf-Filho F, Polara W, Campos GM, Poli-de-Figueiredo LF. Modified Nissen fundoplication: laparoscopic anti-reflux surgery after Roux-en-Y gastric bypass for obesity. Clinics. 2012;67(5):531–3.
Pescarus R, Sharata AM, Dunst CM, Shlomovitz E, Swanstrom LL, Reavis KM. Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass. Surg Endosc. 2016;30(5):2141–2.
Parikh M, Gagner M. Laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after duodenal switch. Surg Obes Relat Dis. 2008;4:73–5.
Anthone GJ. The duodenal switch operation for morbid obesity. Surg Clin North Am. 2005;85(4):819–33.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Shim, J.K., Tayim, R.J., Lehmann, R.K. (2018). Esophageal Reflux Disease Before and After Bariatric Surgery. In: Reavis, K., Barrett, A., Kroh, M. (eds) The SAGES Manual of Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-71282-6_47
Download citation
DOI: https://doi.org/10.1007/978-3-319-71282-6_47
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-71281-9
Online ISBN: 978-3-319-71282-6
eBook Packages: MedicineMedicine (R0)