Sleeve gastrectomy tied to higher GERD risk compared to gastric bypass: Study
Norway: Roux-en-Y gastric bypass (RYGB) is an effective anti-reflux surgery than sleeve gastrectomy (SG) for obese patients, a recent study in the journal Gastroenterology has found.
According to the study, the prevalence of GERD and new-onset of esophagitis and pathological reflux were greater in patients who underwent SG compared to those who underwent RYGB. However, there were no difference in the risk of new-onset esophageal dysmotility between the groups.
Obesity is associated with impaired gastric emptying, increased intra-abdominal pressure, and decreased lower esophageal sphincter (LES) pressure -- all factors predispose for gastroesophageal reflux disease (GERD). Further, patients with type 2 diabetes and obesity have a high prevalence of esophageal motility disorders and GERD.
Roux-en-Y gastric bypass is considered is an effective antireflux procedural, while sleeve gastrectomy may induce or worsen GERD. Previous studies that assessed GERD after SG were limited by unclear GERD definitions, and it is not clear if SG and affects GERD differently. To clarify the same, Jøran Hjelmesæth, Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway, and colleagues aimed to compare the 1-year effects of SG and RYGB on prespecified secondary GERD outcomes from the randomized controlled Oseberg trial, hypothesizing that those who underwent SG would have a higher 1-year risk of subjective and objective measures of GERD.
The study enrolled one hundred twenty-five patients with type 2 diabetes and severe obesity. 16 patients were excluded leaving 109 patients allocated to SG (n ¼ 55) or RYGB (n ¼ 54); 107 patients (98%) completed the 1-year follow-up.
Key findings of the study include:
- At the 1-year follow-up, the prevalence of GERD symptoms was higher in the SG group than in the RYGB group (GSRS-R score 20, 17% vs 6%, P ¼ .070; Gastroesophageal Reflux Disease Questionnaire score 8, 13% vs 2%, P ¼ .026).
- Three of eight patients with GSRS-R 20 had pathologic acid reflux.
- Remission of symptoms was reported by 77%, whereas 7% reported new-onset symptoms, with no between-group differences.
- Erosive esophagitis was diagnosed in 48% of SG patients and 33% of RYGB patients.
- The incidence of new-onset esophagitis was 47% after SG and 9% after RYGB (RD, 38%).
The researchers conclude, "RYGB may be considered an effective anti-reflux surgery compared with SG among patients who are obese."
Reference:
The study titled, "Sleeve Gastrectomy Confers Higher Risk of Gastroesophageal Reflux Disease than Gastric Bypass: A Randomized Controlled Trial From the Oseberg Reflux Working Group," is published in the journal Gastroenterology.
DOI: https://www.sciencedirect.com/science/article/abs/pii/S0016508521034004
