Magnetic Sphincter Augmentation Algorithm for Post-bariatric Surgery Gastroesophageal Reflux Disease Patients

Excerpt

Obesity has been shown to increase the risk of gastroesophageal reflux disease (GERD), with an increased likelihood of esophagogastric junction disruption and increased gastroesophageal pressure gradient [1]. GERD can then produce symptoms such as heartburn, dysphagia, regurgitation, and chest pain, with persistent GERD leading to reflux esophagitis, and esophageal strictures, and metaplasia. Management of weight gain is therefore important to treat GERD in these patients. Despite weight loss being effective in improving GERD, GERD is still an extremely common complication post-bariatric surgery, with 36.7–48.1% of post-sleeve gastrectomy (SG) patients and 16.1–29.2% of post-Roux-en-Y gastric bypass (RYGB) patients taking anti reflux medications 1 year post-op [2, 3]. RYGB is effective in reducing concurrent GERD due to decreased gastric acid production and intragastric pressure while facilitating weight loss. In contrast to RYGB, SG can increase GERD, possibly due to increased intragastric pressure, a weakened lower esophageal sphincter (LES), and changes to the angle of His. While RYGB often alleviates GERD, this is not always the case possibly due to a large pouch and/or a short Roux limb. These complications form a challenge to treating post-bariatric surgery patients with GERD. …