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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2020

01-01-2020 | Obesity | SAGES White Paper

Surgical management of gastroesophageal reflux disease in the obese patient

Authors: P. Nau, H. T. Jackson, A. Aryaie, A. Ibele, D. Shouhed, E. Lo Menzo, M. Kurian, L. Khaitan, SAGES Foregut Task Force White Paper

Published in: Surgical Endoscopy | Issue 1/2020

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Abstract

Background

Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm.

Methods

A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics.

Results

It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed.

Conclusions

Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data.
Literature
1.
Camilleri M, Dubois D, Coulie B et al (2005) Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US upper gastrointestinal study. Clin Gastroenterol Hepatol 3(6):543–552PubMed
2.
El-Serag HB (2007) Time trends of gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol 5(1):17–26PubMed
3.
Kulig M, Leodolter A, Vieth M et al (2003) Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease: an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 18(8):767–776PubMed
4.
Hales C, Carroll, Fryar C, Ogden C (2015) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, No. 288, October 2017
5.
Cawley J, Meyerhoefer C (2012) The medical care costs of obesity: an instrumental variables approach. J Health Econ 31(1):219–230PubMed
6.
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates: amid calls for health reform, real cost savings are more likely to be achieved through reducing obesity and related risk factors. Health Aff 28(Suppl1):w822–w831
7.
8.
9.
10.
Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr (2006) Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med 354(22):2340–2348PubMedPubMedCentral
11.
Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143(3):199–211PubMed
12.
13.
Anand G, Katz PO (2008) Gastroesophageal reflux disease and obesity. Rev Gastroenterol Disord 8(4):233–239PubMed
14.
15.
Kouklakis G, Moschos J, Kountouras J, Mpoumponaris A, Molyvas E, Minopoulos G (2005) Relationship between obesity and gastroesophageal reflux disease as recorded by 3-hour esophageal pH monitoring. Rom J Gastroenterol 14(2):117–121PubMed
16.
17.
18.
Stene-Larsen G, Weberg R, Froyshov Larsen I, Bjortuft O, Hoel B, Berstad A (1988) Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol 23(4):427–432PubMed
19.
Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94(10):2840–2844PubMed
20.
Stefanidis D, Hope WW, Kohn GP et al (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669PubMed
21.
Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 108(3):308–328 (Quiz 329) PubMed
22.
Schietroma M, Piccione F, Clementi M, Cecilia EM, Sista F, Pessia B, Carlei F, Guadagni S, Amicucci G (2017) Short- and long-term, 11–22 years, results after laparoscopic nissen fundoplication in obese versus nonobese patients. J Obes 2017:7589408PubMedPubMedCentral
23.
Frezza EE, Ikramuddin S, Gourash W et al (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 16(7):1027–1031PubMed
24.
Nelson LGGR, Haines K, Gallagher SF, Murr MM (2005) Amelioration of gastroesophageal reflux symptoms following Roux-en-Y gastric bypass for clinically significant obesity. Am Surg 71:950–953PubMed
25.
Madalosso CAS, Gurski RR, Callegari-Jacques SM, Navarini D, Mazzini G, Pereira MDS (2016) The impact of gastric bypass on gastroesophageal reflux disease in morbidly obese patients. Ann Surg 263(1):110–116PubMed
26.
Mejía-Rivas MAH, Hernández-Calleros J, Herrera MF, Valdovinos MA (2008) Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg 18:1217–1224PubMed
27.
Farmer AD, Ruffle JK, Aziz Q (2017) The role of esophageal hypersensitivity in functional esophageal disorders. J Clin Gastroenterol 51(2):91–99PubMed
28.
Anderson SH, Yadegarfar G, Arastu MH, Anggiansah R, Anggiansah A (2006) The relationship between gastro-oesophageal reflux symptoms and achalasia. Eur J Gastroenterol Hepatol 18(4):369–374PubMed
29.
Patterson EJ, Davis DG, Khajanchee Y, Swanström LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17(10):1561–1565PubMed
30.
Perez ARMA, Rattner DW (2001) Obesity adversely affects the outcome of antireflux operations. Surg Endosc 15:986–989PubMed
31.
LE Morgenthal CB, Shane MD, Hunter JG, Smith CD (2007) Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc 21:1978–1984PubMed
32.
Prachand VN, Alverdy JC (2010) Gastroesophageal reflux disease and severe obesity: fundoplication or bariatric surgery? World J Gastroenterol 16:3757–3761PubMedPubMedCentral
33.
34.
Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufman JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2001) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 285(18):2331–2338PubMed
35.
Varela JE, Hinojosa MW, Nguyen NT (2009) Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis 5(2):139–143PubMed
36.
Raftopoulos IAO, Courcoulas AP, Luketich JD (2004) Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg 14:1373–1380PubMed
37.
Ibele AGM, Gould J (2012) The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation. Surg Endosc 26:177–181PubMed
38.
Kellogg TA, Andrade R, Maddaus M, Slusarek B, Buchwald H, Ikramuddin S (2007) Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3(1):52–57 (Discussion 58–59) PubMed
39.
Nadaleto BFHF, Patti MG (2016) Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery 159:475–486PubMed
40.
LE Braghetto I, Korn O, Valladares H, Molina JC, Henriquez A (2010) Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 20:357–362PubMed
41.
Daes JJM, Said N, Daza JC, Dennis R (2012) Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg 22:1874–1879PubMedPubMedCentral
42.
Keidar AAL, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20:140–147PubMed
43.
LA Melissas J, Klinaki I, Perisinakis K, Koukouraki S, de Bree E, Karkavitsas N (2013) Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg 258:976–982PubMed
44.
Alhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Kalantar Motamedi SM, Rahim S, Patel I, Aryaie A, Abbas M, Rogula T, Khaitan L (2018) Does sleeve shape make a difference in outcomes? Obes Surg 28(6):1731–1737PubMed
45.
Del Genio GTS, Limongelli P, Brusciano L, D’Alessandro A, Docimo G, Rossetti G, Silecchia G, Iannelli A, del Genio A, del Genio F, Docimo L (2014) Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg 24:71–77PubMed
46.
Burgerhart JSSC, Schoon EJ, Smulders JF, van de Meeberg PC, Siersema PD, Smout AJ (2014) Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg 24:1436–1441PubMed
47.
Felsenreich DMKR, Schermann M, Beckerhinn P, Kristo I, Krebs M, Prager G, Langer FB (2017) Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg 27:3092–3101PubMed
48.
Genco ASE, Casella G, Maselli R, Castagneto-Gissey L, Di Lorenzo N, Basso N (2017) Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 13:568–574PubMed
49.
DuPree CEBK, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149:328–334PubMed
50.
Sheppard CESD, de Gara CJ, Karmali S, Birch DW (2015) Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg 25:763–768PubMed
51.
Pagé MP, Kastenmeier A, Goldblatt M, Frelich M, Bosler M, Wallace J, Gould J (2014) Medically refractory gastroesophageal reflux disease in the obese: what is the best surgical approach? Surg Endosc 28(5):1500–1504PubMed
52.
Nadaleto BF, Herbella FA, Patti MG (2016) Gastroesophageal reflux disease in the obese: pathophysiology and treatment. Surgery 159(2):475–486PubMed
53.
54.
Oelschlager BK, Pellegrini CA, Hunter JG et al (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213(4):461–468PubMed
55.
Mahawar KK, Carr WR, Jennings N, Balupuri S, Small PK (2015) Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review. Obes Surg 25(1):159–166PubMed
56.
Olmi S, Caruso F, Uccelli M, Cioffi S, Ciccarese F, Cesana G (2017) Laparoscopic sleeve gastrectomy combined with Rossetti fundoplication (R-Sleeve) for treatment of morbid obesity and gastroesophageal reflux. Surg Obes Relat Dis 13(12):1945–1950PubMed
57.
Hawasli A, Reyes M, Hare B, Meguid A, Harriott A, Almahmeed T, Thatimatla N, Szpunar S (2016) Can morbidly obese patients with reflux be offered laparoscopic sleeve gastrectomy? A case report of 40 patients. Am J Surg 211(3):571–576PubMed
58.
Lasnibat JP, Braghetto I, Gutierrez L, Sanchez F (2017) Sleeve gastrectomy and fundoplication as a single procedure in patients with obesity and gastroesophageal reflux. Arq Bras Cir Dig 30(3):216–221PubMedPubMedCentral
59.
Rebecchi F, Allaix ME, Patti MG, Schlottmann F, Morino M (2017) Gastroesophageal reflux disease and morbid obesity: to sleeve or not to sleeve? World J Gastroenterol 23(13):2269–2275PubMedPubMedCentral
60.
Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M (2014) Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 260(5):909–915PubMed
61.
Stenard F, Iannelli A (2015) Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol 21(36):10348–10357PubMedPubMedCentral
62.
Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ (2016) Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 211(1):250–267PubMed
63.
Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Crookes PF (2009) Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 13(8):1440–1447PubMedPubMedCentral
64.
Goitein D, Sakran N, Rayman S, Szold A, Goitein O, Raziel A (2017) Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy. Surg Obes Relat Dis 13(2):138–142PubMed
65.
Ghassemian AJ, MacDonald KG, Cunningham PG, Swanson M, Brown BM, Morris PG et al (1997) The workup for bariatric surgery does not require a routine upper gastrointestinal series. Obes Surg 7(1):16–18PubMed
66.
Schirmer B, Erenoglu C, Miller A (2002) Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 12(5):634–638PubMed
67.
Saarinen T, Kettunen U, Pietiläinen KH, Juuti A (2018) Is preoperative gastroscopy necessary before sleeve gastrectomy and Roux-en-Y gastric bypass? Surg Obes Relat Dis 14(6):757–762PubMed
68.
Telem DA, Gould J, Pesta C et al (2017) American society for metabolic and bariatric surgery: care pathway for laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 13(5):742–749PubMed
69.
Küper MA, Kratt T, Kramer KM, Zdichavsky M, Schneider JH, Glatzle J, Stüker D, Königsrainer A, Brücher BL (2010) Effort, safety, and findings of routine preoperative endoscopic evaluation of morbidly obese patients undergoing bariatric surgery. Surg Endosc 24(8):1996–2001PubMed
70.
Bradley DD, Louie BE, Chen J, Aye RW, McMahon R, Farivar AS (2015) The effect of concurrent esophageal pathology on bariatric surgical planning. J Gastrointest Surg 19(1):111–115 (Discussion 115–116) PubMed
Metadata
Title
Surgical management of gastroesophageal reflux disease in the obese patient
Authors
P. Nau
H. T. Jackson
A. Aryaie
A. Ibele
D. Shouhed
E. Lo Menzo
M. Kurian
L. Khaitan
SAGES Foregut Task Force White Paper
Publication date
01-01-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07231-w

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