Sleeve Gastrectomy Has Higher GERD Risk Than Gastric Bypass

By Reuters Staff

September 13, 2021

(Reuters Health) - People with obesity who undergo bariatric surgery have a higher risk of gastroesophageal reflux disease (GERD) with sleeve gastrectomy than with Roux-en-Y gastric bypass, a randomized controlled trial found.

Researchers randomized patients with severe obesity and type 2 diabetes to undergo either sleeve gastrectomy (n=55) or Roux-en-Y gastric bypass (n=54).

At baseline, 29% of patients had GERD symptoms, defined as a GSRS-R score of 20 or higher. More than half of participants had erosive esophagitis (58%), pathological acid reflux (56%), esophageal dysmotility (54%), or a small hiatal hernia (62%).

One year after surgery, GERD symptoms were significantly more prevalent in the sleeve gastrectomy group (17%) than among patients who underwent gastric bypass (6%), the study team reports in Gastroenterology.

"To our knowledge, this is the first randomized, controlled study to compare the prevalence, remission and incidence of GERD after sleeve gastrectomy versus Roux-en-Y gastric bypass, using a combination of validated questionnaires, 24-hour pH monitoring, high-resolution manometry (HRM) and esophago-gastro-duodenoscopy (EGD)," the authors write.

"Our results support the recent IFSO Position Statement paper recommending that surveillance with EGD should be undertaken routinely after bariatric surgery, regardless of symptom," they conclude.

Participants were eligible for the trial if they had type 2 diabetes and a BMI of 35 or higher. Researchers excluded people with severe GERD, a hiatal hernia greater than 5 cm, or elevated esophageal pressure with symptoms of painful swallowing or dysphagia.

At baseline, participants had a mean age of 47.7 years and a mean BMI of 42.3. The majority of participants (66%) were female. Mean duration of type 2 diabetes was 6.3 years in the sleeve gastrectomy group and 6.6 years in the gastric bypass group.

At one year, participants had a significantly lower mean BMI in the gastric bypass group (BMI 30.3) than in the sleeve gastrectomy group (BMI 32.4).

Significantly more patients were on anti-reflux medications at one year in the sleeve gastrectomy group (22%) than in the gastric bypass group (9%).

Mean GSRS-R scores were also significantly higher at one year in the sleeve gastrectomy group (mean score 9.8) than in the gastric bypass group (mean score 3.7).

One limitation of the study is the relatively short follow-up period, the authors note, although the study is ongoing with the aim of publishing five-year results when available.

Results from primarily white participants with type 2 diabetes also may not be representative of all individuals with obesity who might undergo bariatric surgery, the study team points out. Even so, the results build on previous studies that suggested sleeve gastrectomy might have a higher risk of GERD than gastric bypass.

SOURCE: Gastroenterology, online August 19, 2021.