Top

Open Access 14-04-2025 | Gastroesophageal Reflux Disease | Research

Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study

Authors: Ahmed Mohammed Farid Mahmoud Mansour, Abd El Hamid Ahmed Ghazal, Mohamed Ibrahim Kassem, Elettra Ugliono, Mario Morino, Mostafa Refaie ElKeleny

Published in: Obesity Surgery

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most commonly performed bariatric surgical procedures. The effectiveness of these operations on weight control is well established; however, their impact on esophageal physiology is still under evaluation. The aim of this study is to evaluate the consequences of LSG and LRYGB on esophageal physiology, especially concerning reflux.

Methods

This prospective study involved 30 patients with severe obesity; 15 underwent LSG, and 15 had LRYGB. Conducted between 2021 and 2023 in Turin, Italy, the study employed preoperative and 1-year postoperative assessments of esophageal function using conventional esophageal manometry, 24-h multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal series, upper endoscopy, and a validated questionnaire to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux.

Results

Both groups experienced significant reductions in weight and body mass index, with p-values < 0.001 for both measures. The LRYGB group achieved a significantly higher percentage of excess weight loss compared to the LSG group, with a p-value of < 0.001. In the LSG group, GERD symptoms remained unchanged postoperatively (p = 0.687), with 26.7% using proton pump inhibitors (PPIs) before and after surgery, while in the LRYGB group, GERD symptoms and PPIs use significantly decreased from 53.3 to 6.7% (p = 0.016). Quality of life improved significantly in both groups, with a p-value of 0.001. In the LRYGB group only, esophagitis significantly decreased from 53.3 to 6.7% (p = 0.007), and barium studies showed a significant reduction in reflux signs from 66.7% preoperatively to none postoperatively (p = 0.002). Multichannel intraluminal impedance-pH monitoring revealed significant reductions in reflux metrics for LRYGB group only: total refluxes decreased from 29.0 to 15.0, acidic refluxes from 12.0 to 8.0, and the DeMeester score from 4.70 to 3.70 (p = 0.026, 0.033, and 0.029, respectively). Regarding the manometric parameters, significant changes were observed in the LSG group: total LES length decreased from 34.0 to 31.33 mm (p = 0.027) and residual pressure increased from 2.0 to 4.0 mmHg (p = 0.012), also peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (p < 0.001), while in the LRYGB group, only the LES residual pressure significantly increased from 2.0 to 4.0 mmHg (p = 0.006).

Conclusions

LSG and LRYGB are effective for weight loss and improving quality of life. Sleeve gastrectomy controls reflux, with new cases being rare. Advanced diagnostics are key when standard tests are insufficient.

Graphical Abstract

Azagury DE, Morton JM. Bariatric surgery: overview of procedures and outcomes. Endocrinol Metab Clin North Am. 2016;45(3):647–56. https://doi.org/10.1016/j.ecl.2016.04.013.CrossRefPubMed

Felsenreich DM, Bichler C, Langer FB, et al. Sleeve gastrectomy: surgical technique, outcomes, and complications. Surg Technol Int. 2020;36:63–9.PubMed

Fernández-Ruiz VE, Armero-Barranco D, Xandri-Graupera JM, et al. Roux-en-Y gastric bypass. Biol Res Nurs. 2017;19(2):162–9. https://doi.org/10.1177/1099800416675406.CrossRefPubMed

Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc. 2013;27(4):1260–6. https://doi.org/10.1007/s00464-012-2593-9.CrossRefPubMed

Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2014;10(4):600–5. https://doi.org/10.1016/j.soard.2014.01.017.CrossRef

El-Hadi M, Birch DW, Gill RS, et al. The effect of bariatric surgery on gastroesophageal reflux disease. Can J Surg J Can Chir. 2014;57(2):139–44. https://doi.org/10.1503/cjs.030612.CrossRef

Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024;73(2):361–71. https://doi.org/10.1136/gutjnl-2023-330616.CrossRefPubMed

Balla A, Leone G, Ribichini E, et al. Gastroesophageal reflux disease - health-related quality of life questionnaire: prospective development and validation in Italian. Eur J Gastroenterol Hepatol. 2021;33(3):339–45. https://doi.org/10.1097/meg.0000000000001914.CrossRefPubMed

Ramos AC, Bastos EL, Ramos MG, et al. Technical aspects of laparoscopic sleeve gastrectomy. Arq Bras Cir Dig: ABCD = Braz Arch Dig Surg. 2015;28(Suppl 1):65–8. https://doi.org/10.1590/s0102-6720201500s100018.CrossRef

10.

Schlottmann F, Buxhoeveden R. Laparoscopic Roux-en-Y gastric bypass: surgical technique and tips for success. J Laparoendosc Adv Surg Tech Part A. 2018;28(8):938–43. https://doi.org/10.1089/lap.2018.0393.CrossRef

11.

Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutaneous Tech. 2014;24(1):1–11. https://doi.org/10.1097/sle.0000000000000041.CrossRef

12.

Helmiö M, Victorzon M, Ovaska J, et al. Comparison of short-term outcome of laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: a prospective randomized controlled multicenter SLEEVEPASS study with 6-month follow-up. Scand J Surg: SJS: Off Organ Finn Surg Soc Scand Surg Soc. 2014;103(3):175–81. https://doi.org/10.1177/1457496913509984.CrossRef

13.

Peterli R, Wölnerhanssen BK, Peters T, et al. 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. JAMA. 2018;319(3):255–65. https://doi.org/10.1001/jama.2017.20897.CrossRefPubMedPubMedCentral

14.

Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg. 2014;24(10):1617–24. https://doi.org/10.1007/s11695-014-1258-2.CrossRefPubMed

15.

Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87. https://doi.org/10.1001/jamasurg.2013.3654.CrossRefPubMedPubMedCentral

16.

Raj PP, Bhattacharya S, Misra S, et al. Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2019;15(8):1261–9. https://doi.org/10.1016/j.soard.2019.05.017.CrossRef

17.

Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24(1):71–7. https://doi.org/10.1007/s11695-013-1046-4.CrossRefPubMed

18.

Gadiot RP, Biter LU, van Mil S, et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2017;27(1):59–63. https://doi.org/10.1007/s11695-016-2235-8.CrossRefPubMed

19.

Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the bariatric outcomes longitudinal database. Surg Obes Relat Dis: Off J Am Soc Bariatric ery. 2014;10(3):502–7. https://doi.org/10.1016/j.soard.2013.07.018.CrossRef

20.

Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17(7):894–900. https://doi.org/10.1007/s11695-007-9166-3.CrossRefPubMed

21.

Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS: J Soc Laparoendosc Surg. 2004;8(1):19–23.

22.

Biter LU, van Buuren MMA, Mannaerts GHH, et al. Quality of life 1 year after laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial focusing on gastroesophageal reflux disease. Obes Surg. 2017;27(10):2557–65. https://doi.org/10.1007/s11695-017-2688-4.CrossRefPubMed

23.

Madalosso CA, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients. Ann Surg. 2016;263(1):110–6. https://doi.org/10.1097/sla.0000000000001139.CrossRefPubMed

24.

Jobe BA, Richter JE, Hoppo T, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97. https://doi.org/10.1016/j.jamcollsurg.2013.05.023.CrossRefPubMed

25.

Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450–6. https://doi.org/10.1381/096089206778869933.CrossRefPubMed

26.

Thereaux J, Lesuffleur T, Czernichow S, et al. Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2017;13(6):951–9. https://doi.org/10.1016/j.soard.2016.12.013.CrossRef

27.

Braghetto I, Korn O. Late esophagogastric anatomic and functional changes after sleeve gastrectomy and its clinical consequences with regards to gastroesophageal reflux disease. Dis Esophagus: Off J Int Soc Dis Esophagus. 2019;32(6). https://doi.org/10.1093/dote/doz020.

28.

Barr AC, Frelich MJ, Bosler ME, et al. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy. Surg Endosc. 2017;31(1):410–5. https://doi.org/10.1007/s00464-016-4989-4.CrossRefPubMed

29.

Frezza EE, Ikramuddin S, Gourash W, et al. Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16(7):1027–31. https://doi.org/10.1007/s00464-001-8313-5.CrossRefPubMed

30.

Parmar CD, Mahawar KK, Boyle M, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss. Obes Surg. 2017;27(7):1651–8. https://doi.org/10.1007/s11695-017-2542-8.CrossRefPubMed

31.

Holmberg D, Santoni G, Xie S, et al. Gastric bypass surgery in the treatment of gastro-oesophageal reflux symptoms. Aliment Pharmacol Ther. 2019;50(2):159–66. https://doi.org/10.1111/apt.15274.CrossRefPubMed

32.

Castagneto-Gissey L, Genco A, Del Corpo G, et al. Sleeve gastrectomy and gastroesophageal reflux: a comprehensive endoscopic and pH-manometric prospective study. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2020;16(11):1629–37. https://doi.org/10.1016/j.soard.2020.07.013.CrossRef

33.

Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24. https://doi.org/10.1097/SLA.0b013e3181e90b31.CrossRefPubMed

34.

Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67. https://doi.org/10.1016/j.amjsurg.2015.05.031.CrossRefPubMed

35.

Tai CM, Lee YC, Wu MS, et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obes Surg. 2009;19(5):565–70. https://doi.org/10.1007/s11695-008-9731-4.CrossRefPubMed

36.

Signorini F, Viscido G, Bocco MCA, et al. Impact of gastric bypass on erosive esophagitis and Barret’s esophagus. Obes Surg. 2020;30(4):1194–9. https://doi.org/10.1007/s11695-019-04333-1.CrossRefPubMed

37.

Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–4. https://doi.org/10.1007/s11695-015-1574-1.CrossRefPubMed

38.

Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2017;13(4):568–74. https://doi.org/10.1016/j.soard.2016.11.029.CrossRef

39.

Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2011;7(6):709–13. https://doi.org/10.1016/j.soard.2011.08.003.CrossRef

40.

da Silva JD, Santa-Cruz F, Cavalcanti JMS, et al. Incidence of abnormalities of the gastric tube following sleeve gastrectomy and its role on esophagitis progression. Obes Surg. 2023;33(1):263–7. https://doi.org/10.1007/s11695-022-06375-4.CrossRefPubMed

41.

Kothari V, Shaligram A, Reynoso J, et al. Impact on perioperative outcomes of concomitant hiatal hernia repair with laparoscopic gastric bypass. Obes Surg. 2012;22(10):1607–10. https://doi.org/10.1007/s11695-012-0714-0.CrossRefPubMed

42.

Snyder B, Wilson E, Wilson T, et al. A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2016;12(9):1681–8. https://doi.org/10.1016/j.soard.2016.09.004.CrossRef

43.

Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy–scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19(3):293–8. https://doi.org/10.1007/s11695-008-9791-5.CrossRefPubMed

44.

Näslund I, Beckman KW. Gastric emptying rate after gastric bypass and gastroplasty. Scand J Gastroenterol. 1987;22(2):193–201. https://doi.org/10.3109/00365528708991879.CrossRefPubMed

45.

Thereaux J, Barsamian C, Bretault M, et al. pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy. Br J Surg. 2016;103(4):399–406. https://doi.org/10.1002/bjs.10089.CrossRefPubMed

46.

Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260(5):909–14. https://doi.org/10.1097/sla.0000000000000967. (discussion 14-5).CrossRefPubMed

47.

Peterli R, Wölnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Ann Surg. 2017;265(3):466–73. https://doi.org/10.1097/sla.0000000000001929.CrossRefPubMed

48.

Korenkov M, Köhler L, Yücel N, et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg. 2002;12(1):72–6. https://doi.org/10.1381/096089202321144621.CrossRefPubMed

49.

Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Prelim Results Surg Endosc. 2015;29(7):1760–8. https://doi.org/10.1007/s00464-014-3902-2.CrossRef

50.

Hayat JO, Wan A. The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility. Expert Rev Gastroenterol Hepatol. 2014;8(4):445–52. https://doi.org/10.1586/17474124.2014.888951.CrossRefPubMed

51.

Musella M, Vitiello A, Berardi G, et al. Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial. Surg Endosc. 2021;35(12):6777–85. https://doi.org/10.1007/s00464-020-08182-3.CrossRefPubMed

52.

Ortega J, Escudero MD, Mora F, et al. Outcome of esophageal function and 24-hour esophageal pH monitoring after vertical banded gastroplasty and Roux-en-Y gastric bypass. Obes Surg. 2004;14(8):1086–94. https://doi.org/10.1381/0960892041975497.CrossRefPubMed

53.

Nelson LG, Gonzalez R, Haines K, et al. Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg. 2005;71(11):950–3 (discussion 3–4).CrossRefPubMed

54.

Chern TY, Chan DL, Maani J, et al. High-resolution impedance manometry and 24-hour multichannel intraluminal impedance with pH testing before and after sleeve gastrectomy: de novo reflux in a prospective series. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2021;17(2):329–37. https://doi.org/10.1016/j.soard.2020.09.030.CrossRef

55.

Rebecchi F, Allaix ME, Ugliono E, et al. Increased esophageal exposure to weakly acidic reflux 5 years after laparoscopic Roux-en-Y gastric bypass. Ann Surg. 2016;264(5):871–7. https://doi.org/10.1097/sla.0000000000001775.CrossRefPubMed

56.

Herbella FA, Silva LC, Vicentine FP, et al. Roux-en-Y limb motility after total gastrectomy. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2014;18(5):906–10. https://doi.org/10.1007/s11605-014-2473-9.CrossRef

57.

Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg. 2014;24(9):1436–41. https://doi.org/10.1007/s11695-014-1222-1.CrossRefPubMed

58.

Petersen WV, Meile T, Küper MA, et al. Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity. Obes Surg. 2012;22(3):360–6. https://doi.org/10.1007/s11695-011-0536-5.CrossRefPubMed

59.

Kleidi E, Theodorou D, Albanopoulos K, et al. The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: can it be minimized? Surg Endosc. 2013;27(12):4625–30. https://doi.org/10.1007/s00464-013-3083-4.CrossRefPubMed

60.

Sioka E, Tzovaras G, Tsiopoulos F, et al. Esophageal motility after laparoscopic sleeve gastrectomy. Clin Exp Gastroenterol. 2017;10:187–94. https://doi.org/10.2147/ceg.s128631.CrossRefPubMedPubMedCentral

61.

Crafts TD, Lyo V, Rajdev P, et al. Treatment of achalasia in the bariatric surgery population: a systematic review and single-institution experience. Surg Endosc. 2021;35(9):5203–16. https://doi.org/10.1007/s00464-020-08015-3.CrossRefPubMed

Title: Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study
Authors: Ahmed Mohammed Farid Mahmoud Mansour
Abd El Hamid Ahmed Ghazal
Mohamed Ibrahim Kassem
Elettra Ugliono
Mario Morino
Mostafa Refaie ElKeleny
Publication date: 14-04-2025
Publisher: Springer US
Keywords: Gastroesophageal Reflux Disease
Sleeve Gastrectomy
Esophagitis
Published in: Obesity Surgery
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-025-07818-4

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Chronic Pancreatitis
On-demand Webinar

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Navigating neuroimaging in Alzheimer disease care

Springer Medicine

Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study

Abstract

Background

Methods

Results

Conclusions

Graphical Abstract

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Navigating neuroimaging in Alzheimer disease care

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical Abstract

Please log in to get access to this content

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions