Dag Holmberg1, Giola Santoni1, Shaohua Xie1, Jesper Lagergren1,2. 1. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 2. School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
Abstract
BACKGROUND: Gastric bypass is considered an effective treatment of co-existing gastro-oesophageal reflux (GERD) and obesity. Previous studies have had small sample sizes, short follow-up or substantial loss to follow-up. AIM: To assess the long-term risk of remaining/recurring reflux symptoms after gastric bypass. METHODS: This was a nationwide cohort study of all adults with preoperative reflux who underwent gastric bypass in Sweden between 2006 and 2015, with complete follow-up through 2016. The outcome was remaining/recurring reflux symptoms, defined as use of proton pump inhibitors or histamine-2 receptor antagonists for >6 months after surgery. Cumulative incidence and risk factors of reflux were assessed with multivariable Poisson regression. RESULTS: Among 2454 participants (81.7% female; mean age: 46.1 years, SD: 9.8 years), who were followed for median 4.6 years (interquartile range: 3.1-6.3 years), reflux recurred in 48.8% (95% confidence interval [95% CI], 46.8-51.0) of participants within 2 years of gastric bypass and remained stable up to 10 years after surgery (yearly change in incidence rate ratio [IRR] of 1.00; 95% CI, 0.99-1.02). Risk factors for recurring reflux were high preoperative dose of anti-reflux medication (IRR 1.77; 95% CI, 1.60-1.96 compared with low dose), older age (IRR 1.12; 95% CI 1.02-1.24 comparing age >50 with <40 years), female sex (IRR 1.28; 95% CI, 1.16-1.42) and comorbidity (IRR 1.26; 95% CI, 1.14-1.39 comparing Charlson Comorbidity Index ≥2 with 0). CONCLUSIONS: Reflux symptoms decrease rapidly after gastric bypass, but around half of operated patients require continuous anti-reflux medication. The treatment efficacy of gastric bypass on reflux symptoms might have been overestimated.
BACKGROUND: Gastric bypass is considered an effective treatment of co-existing gastro-oesophageal reflux (GERD) and obesity. Previous studies have had small sample sizes, short follow-up or substantial loss to follow-up. AIM: To assess the long-term risk of remaining/recurring reflux symptoms after gastric bypass. METHODS: This was a nationwide cohort study of all adults with preoperative reflux who underwent gastric bypass in Sweden between 2006 and 2015, with complete follow-up through 2016. The outcome was remaining/recurring reflux symptoms, defined as use of proton pump inhibitors or histamine-2 receptor antagonists for >6 months after surgery. Cumulative incidence and risk factors of reflux were assessed with multivariable Poisson regression. RESULTS: Among 2454 participants (81.7% female; mean age: 46.1 years, SD: 9.8 years), who were followed for median 4.6 years (interquartile range: 3.1-6.3 years), reflux recurred in 48.8% (95% confidence interval [95% CI], 46.8-51.0) of participants within 2 years of gastric bypass and remained stable up to 10 years after surgery (yearly change in incidence rate ratio [IRR] of 1.00; 95% CI, 0.99-1.02). Risk factors for recurring reflux were high preoperative dose of anti-reflux medication (IRR 1.77; 95% CI, 1.60-1.96 compared with low dose), older age (IRR 1.12; 95% CI 1.02-1.24 comparing age >50 with <40 years), female sex (IRR 1.28; 95% CI, 1.16-1.42) and comorbidity (IRR 1.26; 95% CI, 1.14-1.39 comparing Charlson Comorbidity Index ≥2 with 0). CONCLUSIONS: Reflux symptoms decrease rapidly after gastric bypass, but around half of operated patients require continuous anti-reflux medication. The treatment efficacy of gastric bypass on reflux symptoms might have been overestimated.
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