Reflux following bariatric surgery

Abstract

Bariatric surgery is the most effective treatment for morbidly obese patients. Studies investigating the relationship between bariatric surgery and gastroesophageal reflux disease (GERD) are discordant. Depending on the type of intervention, pre-existing GERD can improve, worsen, or develop “de novo” in previously unaffected patients. Therefore, a review of the literature is performed to evaluate the effects of different bariatric surgical procedures on GERD. Currently, the bariatric surgical procedures more frequently performed are laparoscopic sleeve gastrectomy (LSG) and gastric bypass. The majority of studies examining the relationship between GERD and bariatric surgery are low quality, small, and non-randomized. Furthermore, GERD has been investigated through clinical symptoms scales or questionnaires, which often do not correlate with objective endoscopic or functional findings. Therefore, the interpretation of the results of these studies is challenging. Roux-en-Y gastric bypass is considered the preferred surgical operation for bariatric patients with GERD. Despite contradictory results reported among the studies, GERD seems to be a major issue after LSG. Preliminary results on mini-gastric bypass/one anastomosis gastric bypass seem to indicate that biliary reflux might be overrated, but more long-term results are mandatory before drawing conclusions. Further studies are needed to clarify the role of extensive preoperative examinations prior to bariatric surgery, even in asymptomatic patients, and provide clear guidance regarding the indications for the bariatric surgery technique of choice according to the patient’s characteristics.

Keywords

Bariatric surgery / sleeve gastrectomy / Roux-en-Y gastric bypass / one anastomosis gastric bypass / mini-gastric bypass / gastroesophageal reflux disease (GERD)

References

[1] Vakil N,Kahrilas P,Jones R.Global Consensus GroupThe Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.Am J Gastroenterol2006;101:1900-20; quiz 1943

[2] Jacobson BC,Fuchs CS,Camargo CA Jr.Body-mass index and symptoms of gastroesophageal reflux in women.N Engl J Med2006;354:2340-8 PMCID:PMC2782772

[3] Thrift AP,Gammon MD.Obesity and risk of esophageal adenocarcinoma and Barrett’s esophagus: a Mendelian randomization study.J Natl Cancer Inst2014;106:dju252 PMCID:PMC4200028

[4] Ness-Jensen E,El-Serag H.Lifestyle intervention in gastroesophageal reflux disease.Clin Gastroenterol Hepatol2016;14:175-82.e1 PMCID:PMC4636482

[5] Vries DR, van Herwaarden MA, Smout AJ, Samsom M. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index, and esophageal acid exposure.Am J Gastroenterol2008;103:1349-54

[6] Valezi AC,Schlottmann F.Gastroesophageal Reflux Disease in Obese Patients.J Laparoendosc Adv Surg Tech A2018;28:949-52

[7] Che F,Cohen A.Prevalence of hiatal hernia in the morbidly obese.Surg Obes Relat Dis2013;9:920-4

[8] Wu JC,Cheung CM,Sung JJ.Obesity is associated with increased transient lower esophageal sphincter relaxation.Gastroenterology2007;132:883-9

[9] O’Brien PE,Brennan L.Long-Term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding.Obes Surg2019;29:3-14 PMCID:PMC6320354

[10] English WJ,Hutter MM.American society for metabolic and bariatric surgery 2018 estimate of metabolic and bariatric procedures performed in the United States.Surg Obes Relat Dis2020;16:457-63

[11] Zhao H.Comparative analysis for the effect of Roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: Evidence from 11 randomized clinical trials (meta-analysis).Int J Surg2019;72:216-23

[12] Zellmer JD,Kallies KJ.Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis.Am J Surg2014;208:903-10; discussion 909-10

[13] Hutter MM,Jones DB.First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass.Ann Surg2011;254:410-20; discussion 420 PMCID:PMC3339264

[14] Altieri MS.Gastroesophageal reflux disease after bariatric procedures.Surg Clin North Am2015;95:579-91

[15] Nadaleto BF,Patti MG.Gastroesophageal reflux disease in the obese: Pathophysiology and treatment.Surgery2016;159:475-86

[16] Oor JE,Ünlü Ç.Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis.Am J Surg2016;211:250-67

[17] Yeung KTD,Ashrafian L,Ashrafian H.Does sleeve gastrectomy expose the distal esophagus to severe reflux?.Ann Surg2020;271:257-65

[18] Rebecchi F,Giaccone C.Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation.Ann Surg2014;260:909-14; discussion 914

[19] Balla A,Palmieri L.Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review.Langenbecks Arch Surg2021;406:2591-609 PMCID:PMC8803809

[20] Levy JL,Rubesin SE,Dumon KR.Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings.Br J Radiol2018;91:20170702 PMCID:PMC6223153

[21] Burgos AM,Braghetto I.Gastric stenosis after laparoscopic sleeve gastrectomy in morbidly obese patients.Obes Surg2013;23:1481-6

[22] Deręgowska-Cylke M,Cylke R.Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations.Pol J Radiol2021;86:e325-34 PMCID:PMC8186309

[23] Toro JP,Patel AD.Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy.J Am Coll Surg2014;219:430-8

[24] Rosenthal RJ,Arvidsson D.International Sleeve Gastrectomy Expert PanelInternational sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases.Surg Obes Relat Dis2012;8:8-19

[25] Chen W,Wang C.Chinese Obesity and Metabolic Surgery CollaborativeEffect of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastroesophageal reflux disease in patients with obesity: a systematic review and meta-analysis.Obes Surg2021;31:3905-18

[26] Małczak P,Zarzycki P,Major P.Hiatal hernia repair during laparoscopic sleeve gastrectomy: systematic review and meta-analysis on gastroesophageal reflux disease symptoms changes.Pol Przegl Chir2021;93:1-5

[27] Carandina S,Nedelcu A.Is it safe to combine a fundoplication to sleeve gastrectomy?.Medicina (Kaunas)2021;57:392 PMCID:PMC8073310

[28] Olmi S,Cesana GC.Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up.Surg Obes Relat Dis2020;16:1202-11

[29] Amor IB,Vanbiervliet G.The Nissen-sleeve (N-Sleeve): results of a cohort study.Obes Surg2020;30:3267-72

[30] Brown WA,Balalis G.IFSO position statement on the role of esophago-gastro-duodenal endoscopy prior to and after bariatric and metabolic surgery procedures.Obes Surg2020;30:3135-53

[31] Campos GM,Altieri MS.Clinical Issues Committee of the American Society for Metabolic and Bariatric SurgeryASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery.Surg Obes Relat Dis2021;17:837-47

[32] Maciejewski ML,Van Scoyoc L.Bariatric surgery and long-term durability of weight loss.JAMA Surg2016;151:1046-55 PMCID:PMC5112115

[33] Madalosso CA,Callegari-Jacques SM.The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients.Ann Surg2016;263:110-6

[34] Mejía-Rivas MA,Hernández-Calleros J,Valdovinos MA.Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass.Obes Surg2008;18:1217-24

[35] Peterli R,Peters T.Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial.JAMA2018;319:255-65 PMCID:PMC5833546

[36] Signorini F,Bocco MCA,Moser F.Impact of gastric bypass on erosive esophagitis and Barret’s esophagus.Obes Surg2020;30:1194-9

[37] Adil MT,Rashid F.A systematic review and meta-analysis of the effect of Roux-en-Y gastric bypass on Barrett’s esophagus.Obes Surg2019;29:3712-21

[38] Fisher OM,Talbot ML.Barrett’s oesophagus and bariatric/metabolic surgery-IFSO 2020 position statement.Obes Surg2021;31:915-34

[39] Rebecchi F,Ugliono E.Increased esophageal exposure to weakly acidic reflux 5 years after laparoscopic Roux-en-Y gastric bypass.Ann Surg2016;264:871-7

[40] McKinley SK,Walsh D.Surgical treatment of GERD: systematic review and meta-analysis.Surg Endosc2021;35:4095-123

[41] Perez AR,Rattner DW.Obesity adversely affects the outcome of antireflux operations.Surg Endosc2001;15:986-9

[42] Morgenthal CB,Shane MD,Smith CD.Who will fail laparoscopic Nissen fundoplication?.Surg Endosc2007;21:1978-84

[43] Abdelrahman T,Chan DS.Outcomes after laparoscopic anti-reflux surgery related to obesity: a systematic review and meta-analysis.Int J Surg2018;51:76-82

[44] NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.Ann Intern Med1991;115:956-61

[45] Stefanidis D,Kohn GP.SAGES Guidelines CommitteeGuidelines for surgical treatment of gastroesophageal reflux disease.Surg Endosc2010;24:2647-69

[46] Fuchs KH,Breithaupt W.European Association of Endoscopic Surgery (EAES)EAES recommendations for the management of gastroesophageal reflux disease.Surg Endosc2014;28:1753-73

[47] Munie S,Gould JC.Salvage options for fundoplication failure.Curr Gastroenterol Rep2019;21:41

[48] Furnée EJ,Broeders IA.Surgical reintervention after failed antireflux surgery: a systematic review of the literature.J Gastrointest Surg2009;13:1539-49 PMCID:PMC2710493

[49] Shao JM,Prasad T.Best reoperative strategy for failed fundoplication: redo fundoplication or conversion to Roux-en-Y gastric diversion?.Surg Endosc2021;35:3865-73

[50] Yamamoto SR,Nandipati KC,Mittal SK.Long-term outcomes of reintervention for failed fundoplication: redo fundoplication versus Roux-en-Y reconstruction.Surg Endosc2014;28:42-8

[51] Matar R,Jaruvongvanich V.Indications and outcomes of conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a systematic review and a meta-analysis.Obes Surg2021;31:3936-46

[52] Mason EE.Gastric bypass in obesity. 1967.Obes Res1996;4:316-9

[53] Lee WJ,Lee YC.Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.Obes Surg2012;22:1827-34

[54] Mahawar KK,Balupuri S.Controversy surrounding “mini” gastric bypass.Obes Surg2014;24:324-33

[55] Kermansaravi M,Davarpanah Jazi AH.Revisional surgery after one anastomosis/mini gastric bypass: a narrative review.J Res Med Sci2020;25:62 PMCID:PMC7554535

[56] Collins BJ,Schweitzer M,Harmon JW.Gastric bypass: why Roux-en-Y?.Arch Surg2007;142:1000-3; discussion 1004

[57] McCarthy HB,Chan EK.Gastritis after gastric bypass surgery.Surgery1985;98:68-71

[58] De Luca M,Ooi G.Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement.Obes Surg2018;28:1188-206

[59] De Luca M,Merola G.IFSO update position statement on one anastomosis gastric bypass (OAGB).Obes Surg2021;31:3251-78

[60] Ren CJ,Gagner M.Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients.Obes Surg2000;10:514-23; discussion 524

[61] Buchwald H,Fahrbach K.Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.Am J Med2009;122:248-256.e5

[62] Risstad H,Engström M.Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial.JAMA Surg2015;150:352-61

[63] Buchwald H,Fahrbach K,Sledge I.Trends in mortality in bariatric surgery: a systematic review and meta-analysis.Surgery2007;142:621-32; discussion 632

[64] Anderson B,de Gara CJ,Gagner M.Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations.Gastroenterol Res Pract2013;2013:974762 PMCID:PMC3929999

[65] Bolckmans R.Long-term (> 10 Yrs) Outcome of the laparoscopic biliopancreatic diversion with duodenal switch.Ann Surg2016;264:1029-37

[66] Badaoui JN,Abu Dayyeh BK.The outcomes of laparoscopic biliopancreatic diversion with duodenal switch on gastro-esophageal reflux disease: the mayo clinic experience.Obes Surg2021;31:4363-70

[67] Bashah M,Baazaoui J.Single Anastomosis duodeno-ileostomy (SADI-S) versus one anastomosis gastric bypass (OAGB-MGB) as revisional procedures for patients with weight recidivism after sleeve gastrectomy: a comparative analysis of efficacy and outcomes.Obes Surg2020;30:4715-23 PMCID:PMC7719107

[68] Merz AE,Gagner M.Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel.Surg Obes Relat Dis2019;15:894-9

[69] Sánchez-Pernaute A,Pérez-Aguirre E.Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique.Obes Surg2007;17:1614-8

[70] Shoar S,Rubenstein R.Single anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety.Obes Surg2018;28:104-13