Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 8/2020

01-08-2020 | Obesity | Review

Gastroesophageal Reflux Disease, Obesity, and Roux-en-Y Gastric Bypass: Complex Relationship—a Narrative Review

Author: Michel Suter

Published in: Obesity Surgery | Issue 8/2020

Login to get access

Abstract

Common, gastroesophageal reflux disease (GERD) is promoted by increased abdomino-thoracic pressure gradient and affects a large proportion of patients with obesity. Weight loss is one of the mainstays of conservative treatment. While fundoplication is recognized as the best surgical option in the general population, its results in severely obese individuals are controversial. Roux-en-Y gastric bypass (RYGB) is a widely used bariatric procedure and has been shown to also result in major improvement of GERD through various mechanisms, including weight loss. RYGB is considered by many as the procedure of choice to treat patients with both severe obesity and GERD. Not all patients are free from GERD symptoms after RYGB, though, a therapeutic challenge. This narrative review discusses the complex interactions between obesity, GERD, and RYGB.
Literature
1.
Fletcher J, Wirz A, Young J, et al. Unbuffered highly acidic gastric juice exists at the gastro-esophageal junction after a meal. Gastroenterology. 2001;221:775–83.
2.
Tack J, Pandolfino JE. Pathophysiology of gastroesophageal reflux disease. Gastroenterology. 2018;154:277–88.PubMed
3.
Mittal RK, Lange RC, McCallum RW. Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology. 1987;92:130–5.PubMed
4.
El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastrooesophageal reflux disease: a systematic review. Gut. 2014;63:871–80.PubMed
5.
Goyal RK. Diseases of the esophagus. In: Harrison’s principles of internal medicine. 14th ed. New York: McGraw-Hill; 1998. p. 1588–96.
6.
Kahrilas PJ. Gastroesophageal reflux disease and its complications. In: Feldman M, Sleisinger MH, Scharschmidt BF, editors. Gastrointestinal and liver disease, vol. 1. 6th ed. Philadelphia: Saunders; 1998. p. 498–517.
7.
Ness-Jensen E, Hveem K, El-Serag H, et al. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2018;14:175–82.
8.
Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in patients considered for bariatric surgery. Dig Liver Dis. 2019;51:1375–9.PubMed
9.
Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.PubMed
10.
Suter M, Dorta G, Giusti V, et al. Gastroesophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14:959–66.PubMed
11.
Mora F, Cassinello N, Mora M, et al. Esophgeal abnormalities in morbidly obese adult patients. Surg Obes Relat Dis. 2016;12:622–8.PubMed
12.
Locke III GR, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–9.PubMed
13.
El Serag HB, Ergun GA, Pandolfino J, et al. Obesity increases oesophageal acid exposure. Gut. 2007;56:749–55.PubMed
14.
Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840–4.PubMed
15.
Pandolfino JE. The relation between obesity and GERD: “big or overblown”. Am J Gastroenterol. 2008;103:1355–7.PubMed
16.
Del Grande L, Herbella FAM, Katayama RC, et al. The role of transdiaphragmatic pressure gradient in the pathophysiology of gastroesophageal reflux disease. Arq Gastroenterol. 2018;55(suppl 1):13–7.
17.
18.
Anvari M, Bamehriz F. Outcome of laparoscopic Nissen fundoplication in patients with body mass index ≥ 35. Surg Endosc. 2006;20:230–4.PubMed
19.
Chisholm JA, Jamieson GG, Lally CG, et al. The effect of obesity on the outcome of laparoscopic antireflux surgery. J Gastrointest Surg. 2009;13:1064–70.PubMed
20.
D’Alessio MJ, Arnaoutakis D, Giarelli N, et al. Obesity is not a contraindication to laparoscopic Nissen fundoplication. J Gastrointest Surg. 2005;9:949–54.PubMed
21.
Winslow ER, Frisella MM, Soper NJ, et al. Obesity does not adversely affect the outcome of laparoscopic antireflux surgery (LARS). Surg Endosc. 2003;17:2003–11.PubMed
22.
Luketina RR, Koch OO, Köhler G, et al. Obesity does not affect the outcome of laparoscopic antireflux surgery. Surg Endosc. 2015;29:1327–33.PubMed
23.
Ng VV, Booth MI, Stratford JJ, et al. Laparoscopic anti-reflux surgery is effective in obese patients with gastro-oesophageal reflux disease. Ann R Coll Surg Engl. 2007;89:696–702.PubMedPubMedCentral
24.
Telem DA, Altieri M, Gracia G, et al. Perioperative outcome of esophageal fundoplication for gastroesophagel reflux disease in obese and morbidly obese patients. Am J Surg. 2014;208:163–8.PubMed
25.
Tekin K, Toydemir T, Yerdel MA. Is laparoscopic antireflux surgery safe and effective in obese patients? Surg Endosc. 2012;26:86–95.PubMed
26.
Fraser J, Watson DI, O’Boyle CJ, et al. Obesity and its effect on outcome after laparoscopic fundoplication. Surg Endosc. 2001;14:50–3.
27.
Hahnloser D, Schumacher M, Cavin R, et al. Risk factors for complications after laparoscopic Nissen fundoplication. Surg Endosc. 2002;16:43–7.PubMed
28.
Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.PubMed
29.
Morgenthal CB, Lin E, Shane ND, et al. Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007;21:1978–84.PubMed
30.
Kellogs TA, Andrade R, Maddaus M, et al. Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3:52–7.
31.
Jones KB, Allen TV, Manas KJ, et al. Roux-en-Y gastric bypass: an effective anti-reflux procedure. Obes Surg. 1991;1:295–8.PubMed
32.
Jones KB. Roux-en-Y gastric bypass: an effective antireflux procedure in the less than morbidly obese. Obes Surg. 1998;8:35–8.PubMed
33.
Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997;7:479–84.PubMed
34.
Frezza EE, Ikramuddin S, Gouras W. Symptomatic improvement of gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2002;16:1027–31.PubMed
35.
Mejia-Rivas MA, Herrera-Lopez A, Hernandez-Calleros J, et al. Gastroesophageal reflux disease in morbid obesity. The effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18:1217–24.PubMed
36.
Signorini F, Viscido G, Bocco MCA, et al. Impact of gastric bypass on erosive esophagitis and Barrett’s esophagus. Obes Surg. 2020;30:1194–9.PubMed
37.
Barr AC, Frelich MJ, Bosler ME, et al. GERD and acid reduction medication use following gastric bypass and sleeve gastrectomy. Surg Endosc. 2017;31:410–5.PubMed
38.
Smith CD, Herkes SB, Behrns KE, et al. Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 1993;218:91–6.PubMedPubMedCentral
39.
Houghton SG, Romero Y, Sarr MG. Effect of Roux-en-Y gastric bypass in obese patients with Barrett’s esophagus: attempts to eliminate duodenogastric reflux. Surg Obes Relat Dis. 2008;4:1–5.PubMed
40.
Csendes A, Burgos AM, Smok G, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10:259–64.PubMed
41.
Felsenreich DM, Langer FB, Bichler C, et al. Roux-en-Y gastric bypass as a treatment for Barrett’s esophagus after sleeve gastrectomy. Obes Surg. 2020;30:1273–9.PubMed
42.
Tanveer Adil MD, Al-Taan O, Rashid F, et al. A systematic review and meta-analysis on the effect of gastric bypass on Barrett’s esophagus. Obes Surg. 2019;29:3712–21.
43.
Madalosso CAS, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity. A prospective study based on the Montreal consensus. Ann Surg. 2010;251:244–8.PubMed
44.
Madalosso CAS, Gurski RR, Callegari-Jacques SM, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity. Ann Surg. 2016;263:110–6.PubMed
45.
Holmberg D, Santoni G, Xie S, et al. Gastric bypass surgery in the treatment of gastro-oesophageal reflux symptoms. Aliment Pharmacol Ther. 2019;50:159–66.PubMed
46.
Varban OA, Hawasli A, Carlin AM, et al. Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis. 2015;11:222–9.PubMed
47.
Varela JE, Hinojosa MW, Nguyen NT. Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis. 2009;5:139–45.PubMed
48.
Patterson EJ, Davis DG, Khajanchee Y, et al. Comparison of objective outcomes following laparoscopic Nissen fundoplication vs laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc. 2003;17:1561–5.PubMed
49.
Herbella FAM, Schlottmann F, Patti MG. Pathophysiology of gastroesophageal reflux disease: how and antireflux procedure works (or does not work). Updates Surg. 2018;70:343–7.PubMed
50.
Olbeid NR, Altieri MS, Yang J, et al. Patterns of reoperation after failed fundoplication: an analysis of 9462 patients. Surg Endosc. 2018;32:345–50.
51.
Wakeam E, Wee J, Lebenthal A, et al. Does BMI predict recurrence or complications after reoperative reflux surgery? Review of a single center’s. Experience and a comparison of outcomes. J Gastrointest Surg. 2014;18:1965–73.PubMed
52.
Raftopoulos I, Awais O, Courcoulas AP, et al. Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg. 2004;14:1373–80.PubMed
53.
Houghton SG, Nelson LG, Swain JM, et al. Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis. 2005;1:475–80.PubMed
54.
Ibele A, Garren M, Gould J. The impact of previous fundoplication on laparoscopic gastric bypass outcomes: a case-control evaluation. Surg Endosc. 2012;26:177–81.PubMed
55.
Gys B, Gys T, Laffularde T. The efficacy of laparoscopic Roux-En-Y gastric bypass after previous anti-reflux surgery : a single surgeon expérience. Acta Chir Belg. 2015;115:268–72.PubMed
56.
Coakley KM, Groene SA, Colovita PD, et al. Roux-en-Y gastric bypass following failed fundoplication. Surg Endosc. 2018;32:3517–24.PubMed
57.
Stefanidis D, Navarro F, Augenstein VA, et al. Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc. 2012;26:3521–7.PubMed
58.
Watson MT, Mehaffey JH, Schirmer BD, et al. Roux-en-Y gastric bypass following Nissen fundoplication: higher risk same reward. Obes Surg. 2017;27:2398–403.PubMedPubMedCentral
59.
Mendes-Filho AM, Godoy ESM, Alhinho HCAW, et al. Fundoplication conversion in Roux-en-Y gastric bypass for control of obesity and gastroesophageal reflux: systematic review. Arq Bras Cir Dig. 2017;30:279–82.PubMedPubMedCentral
60.
Baretta G, Al Mulla AE, Jimenez-Lopes MA, et al. Laparoscopic Roux-en-Y gastric bypass after gastroesophageal reflux disease surgical procedure: analysis of 85 consecutive patients with pre and post-operative endoscopy control. J Laparoendosc Adv Surg Tech A. 2020;30:40–3.PubMed
61.
Deitel M, Khanna RK, Hagen J, et al. Vertical banded gastroplasty as an antireflux procedure. Am J Surg. 1988;155:512–6.PubMed
62.
Gagné DJ, Dovec E, Urbandt JE. Laparoscopic revision of vertical banded gastroplasty to Roux-en-Y gastric bypass : outcomes in 105 patients. Surg Obes Relat Dis. 2011;7:493–9.PubMed
63.
Ekelund M, Oberg S, Peterli R, et al. Gastro-oesphageal reflux after vertical banded gastroplasty is alleviated by conversion to gastric bypass. Obes Surg. 2012;22:851–4.PubMed
64.
Korenkov M, Köhler L, Yücel N, et al. Esophageal motility and reflux symptoms before and after bariatric surgery. Obes Surg. 2002;12:72–6.PubMed
65.
Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity : the effect of lap-band placement. Obes Surg. 1999;9:527–31.PubMed
66.
Gutschow CA, Collet P, Prenzel K, et al. Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. J Gastrointest Surg. 2005;9:941–8.PubMed
67.
Suter M, Dorta G, Giusti V, et al. Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg. 2005;140:639–43.PubMed
68.
Apers JA, Wens C, van Vlodorp V, et al. Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis. Surg Endosc. 2013;27:558–64.PubMed
69.
Daes J, Jimenez ME, Said N, et al. Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg. 2014;24:536–40.PubMed
70.
Soricelli E, Iossa A, Casella G, et al. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9:356–61.PubMed
71.
Samakar K, McKenzie TJ, Tavakkoli A, et al. The effect of laparoscopic sleeve gastrectomy with concomitant hiatal repair on gastroesophageal reflux disease in the morbidly obese. Obes Surg. 2016;26:61–6.PubMed
72.
Van Wieren IA, Thumma JR, Obeid NR, et al. The influence of gastroesophageal reflux symptoms on patient satisfaction after sleeve gastrectomy. Surgery. 2019;166:873–8.PubMed
73.
Thereaux J, Barsamian C, Bretault M, et al. pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy. Br J Surg. 2016;103:399–406.PubMed
74.
Borbély Y, Schaffner E, Zimmermann L, et al. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc. 2019;33:789–93.PubMed
75.
Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilation and Barrett’s esophagus after laparoscopic sleeve gastrectomy. Long-term follow-up. Obes Surg. 2017;27:3092–101.PubMed
76.
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. 2017;13:568–74.PubMed
77.
Sebastianelli L, Benoit M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29:1462–9.PubMed
78.
Nocca D, Skalli EM, Boulay E, et al. Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis. 2016;12:1832–7.PubMed
79.
Del Genio G, Tolone S, Gambardella C, et al. Sleeve gastrectomy and anterior fundoplication (D-Sleeve) prevents gastroesophageal reflux in symptomatic GERD. Obes Surg. 2020;30:1642–52.PubMed
80.
81.
Adil MT, Aminian A, Bhasker AG, et al. Perioperative practices concerning sleeve gastrectomy – a survey of 863 surgeons with a cumulative experience of 520,230 procedures. Obes Surg. 2020;30:483–92.PubMed
82.
Berger EH. The distribution of parietal cells in the stomach: a histotopographic study. Am J Pathol. 1934;54:87–114.
83.
Siilin H, Wanders A, Gustavsson S, et al. The proximal gastric pouch invariably contains parietal cells in Roux-en-Y gastric bypass. Obes Surg. 2005;15:771–7.PubMed
84.
Herbella FAM, Vicentine FPP, Del Grande JC, et al. Postprandial proximal gastric acid pocket in patients after Roux-en-Y gastric bypass. J Gastrointest Surg. 2010;14:1742–5.PubMed
85.
Swartz DE, Mobley E, Felix EL. Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain. Surg Obes Relat Dis. 2009;5:27–30.PubMed
86.
Gagné DJ, St Germaine N, Urbandt JE. Laparoscopic revision of Roux-en-Y gastric bypass for dysphagia and bile reflux. Surg Obes Relat Dis. 2010;6:551–3.PubMed
87.
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;264:271–7.
88.
Pallati PK, Shaligram A, Shostrom V, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2014;10:502–7.PubMed
89.
Duvoisin C, Favre L, Allemann P, et al. Roux-en-Y gastric bypass : 10-year results in a cohort of 658 patients. Ann Surg. 2018;268:1019–25.PubMed
90.
Peterli R, Wölnerhanssen BK, Peters T, et al. Effects of sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity. The SM-BOSS randomized clinical trial. JAMA. 2018;319:255–65.PubMedPubMedCentral
91.
Borbély Y, Kröll D, Nett PC, et al. Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2018;14:764–8.PubMed
92.
Chen RH, Lautz D, Gilbert RJ, et al. Antireflux operation for gastroesophageal reflux after Roux-en-Y gastric bypass for obesity. Ann Thorac Surg. 2005;80:1938–40.PubMed
93.
Kawahara NK, Alster C, Maluf-Filho F, et al. Modified Nissen fundoplication: laparoscopic antireflux surgery after Roux-en-Y gastric bypass for obesity. Clinics. 2012;67:531–3.PubMedPubMedCentral
94.
Vorwald P, Restrepo-Núñes RM, Cabañas GS, et al. Laparoscopic Toupet fundoplication after Roux-en-Y gastric bypass in patient with severe GERD. Obes Surg. 2019;29:1432.PubMed
95.
Pescarus R, Sharata AM, Dunst CM, et al. Hill procedure for recurrent GERD post-Roux-en-Y gastric bypass. Surg Endosc. 2016;30:2141–2.PubMed
96.
97.
Mattar SG, Qureshi F, Taylor D, et al. Treatment of refractory gastroesophageal reflux disease with radiofrequency energy (Stretta) in patients after Roux-en-Y gastric bypass. Surg Endosc. 2006;20:850–4.PubMed
98.
Muñoz-Largacha JA, Hess DT, Litle VR, et al. Lower esophageal magnetic sphincter augmentation for persistent reflux after Roux-en-Y gastric bypass. Obes Surg. 2016;26:464–6.PubMed
99.
Hawasli A, Phillips A, Tarboush M. Laparoscopic management of reflux after Roux-en-Y gastric bypass using the LINX system and repair of hiatal hernia: a case report. Surg Obes Relat Dis. 2016;12:e51–4.PubMed
100.
101.
Varshney S, Kelly JJ, Branagan G, et al. Angelchik prosthesis revisited. World J Surg. 2002;26:129–33.PubMed
102.
Alicuben ET, Bell RCW, Jobe BA, et al. Worldwide experience with erosion of the magnetic sphincter augmentation device. J Gastrointest Surg. 2018;22:1442–7.PubMed
Metadata
Title
Gastroesophageal Reflux Disease, Obesity, and Roux-en-Y Gastric Bypass: Complex Relationship—a Narrative Review
Author
Michel Suter
Publication date
01-08-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04690-2

Other articles of this Issue 8/2020

Obesity Surgery 8/2020 Go to the issue

Original Contributions

Management of 69 Gastric Leakages after 4294 Consecutive Sleeve: The Experience of a High Volume Bariatric Center

Letter to the Editor

Letter to the Editor Re: “Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery”

Letter to the Editor

Letter to the Editor: Intragastric Balloon Removal During the COVID-19 Pandemic: to Postpone or Not? That Is the Question

Correction

Correction to: Endoscopic Argon Plasma Coagulation Vs. Multidisciplinary Evaluation in the Management of Weight Regain after Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group

Original Contributions

Role of Endoscopic Stent Insertion on Management of Gastric Twist after Sleeve Gastrectomy

Original Contributions

An Evaluation of the Modern North American Bariatric Surgery Landscape: Current Trends and Predictors of Procedure Selection