P Praveen Raj1, Siddhartha Bhattacharya2, Shivanshu Misra2, S Saravana Kumar2, Mohd Juned Khan3, Sridhar Chinnaswami Gunasekaran3, C Palanivelu4. 1. Department of Bariatric & Metabolic Surgery, GEM Hospital & Research Centre, Coimbatore, India. Electronic address: drraj@geminstitute.in. 2. Department of Bariatric & Metabolic Surgery, GEM Hospital & Research Centre, Coimbatore, India. 3. Department of Medical Gastroenterology, GEM Hospital & Research Centre, Coimbatore, India. 4. Department of Surgical Gastroenterology, GEM Hospital & Research Centre, Coimbatore, India.
Abstract
BACKGROUND: The development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited. OBJECTIVE: The objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB. SETTINGS: Tertiary care teaching hospital, India. METHODS: This registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, open-label clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERD patients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively. RESULTS: Thirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 ± 11.8 to 40.2 ± 38.6 (P = .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 ± 4.6 to 12.2 ± 17.2 after LRYGB was not significant (P = .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB. CONCLUSION: The incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD.
BACKGROUND: The development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited. OBJECTIVE: The objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB. SETTINGS: Tertiary care teaching hospital, India. METHODS: This registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, open-label clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERDpatients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively. RESULTS: Thirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 ± 11.8 to 40.2 ± 38.6 (P = .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 ± 4.6 to 12.2 ± 17.2 after LRYGB was not significant (P = .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB. CONCLUSION: The incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD.
Keywords:
De novo GERD after sleeve gastrectomy; GERD after bariatric surgery; Gastroesophageal reflux disease after bariatric surgery; Gastroesophageal reflux disease after gastric bypass; Gastroesophageal reflux disease after sleeve gastrectomy; Incidence of GERD after sleeve gastrectomy; Manometry changes after gastric bypass; Manometry changes after sleeve gastrectomy; pH study changes after gastric bypass; pH study changes after sleeve gastrectomy
Authors: Ray Portela; Ahmet Vahibe; Joseph N Badaoui; Omer U I Hassan; Travis J Mckenzie; Todd A Kellogg; Omar M Ghanem Journal: Bariatr Surg Pract Patient Care Date: 2022-06-08 Impact factor: 0.368
Authors: Veeravich Jaruvongvanich; Reem Matar; Karthik Ravi; M Hassan Murad; Kornpong Vantanasiri; Nicha Wongjarupong; Patompong Ungprasert; Eric J Vargas; Daniel B Maselli; Larry J Prokop; Barham K Abu Dayyeh Journal: Clin Transl Gastroenterol Date: 2020-08 Impact factor: 4.396