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Obesity Surgery
Published in: Obesity Surgery 4/2020

01-04-2020 | Obesity | Original Contributions

Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass

Authors: Daniel Navarini, Carlos Augusto S. Madalosso, Alexandre P. Tognon, Fernando Fornari, Fábio R. Barão, Richard R. Gurski

Published in: Obesity Surgery | Issue 4/2020

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Abstract

Objective

To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity.

Methods

Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery.

Results

Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m2): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m2 vs. 42.7 ± 5.7 kg/m2; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78–40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9–52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6–44.8), and age (OR 2.0, 95%CI 1.1–3.4).

Conclusions

One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
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Metadata
Title
Predictive Factors of Gastroesophageal Reflux Disease in Bariatric Surgery: a Controlled Trial Comparing Sleeve Gastrectomy with Gastric Bypass
Authors
Daniel Navarini
Carlos Augusto S. Madalosso
Alexandre P. Tognon
Fernando Fornari
Fábio R. Barão
Richard R. Gurski
Publication date
01-04-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 4/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04286-5

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