The effect of bariatric surgery on gastroesophageal reflux disease

The effect of bariatric surgery on gastroesophageal reflux disease

Can J Surg 2014;57(2)139-144 | Full Text | PDF

Mustafa El-Hadi, MD*; Daniel W. Birch, MD†; Richdeep S. Gill, MD, PhD*; Shahzeer Karmali, MD, MPH*†

From the *Department of Surgery, University of Alberta, and the †Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandria Hospital, Edmonton, Alta.

Abstract

Obesity is an epidemic that is known to play a role in the development of gastroesophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en- Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD.

Résumé

L’obésité atteint des proportions épidémiques et on sait qu’elle joue un rôle dans l’apparition du phénomène de reflux gastro-oesophagien (RGO). Des études ont montré que l’augmentation de l’indice de masse corporelle contribue à l’incompétence de la jonction entre l’oesophage et l’estomac et que la perte de poids et des modifications de l’hygiène de vie réduisent les symptômes de RGO. Comme méthode pour obtenir une perte de poids efficace et durable, la chirurgie bariatrique occupe une place importante dans le traitement de l’obésité. Nous avons passé en revue la littérature traitant des effets de différents types de chirurgie bariatrique sur le soulagement des symptômes du RGO et ses complications. La dérivation gastrique Roux-en-Y a été considérée comme une méthode efficace pour le soulagement des symptômes de RGO, tandis que la gastrectomie verticale par laparoscopie a semblé faire augmenter l’incidence de la maladie. Quant au cerclage gastrique ajustable, il a semblé améliorer initialement le RGO; toutefois chez une catégorie de patients, le RGO s’est manifesté de nouveau lors du suivi à long terme. Selon la littérature, chaque type d’intervention exerce un impact différent sur la symptomatologie du RGO et une évaluation soigneuse s’impose avant de procéder à une chirurgie bariatrique chez les patients souffrant de RGO.


Accepted for publication May 6, 2013

Competing interests: S. Karmali is a consultant for Ethicon Endo-Surgery and Covidien. D.W. Birch is a consultant for Johnson & Johnson, Ethicon Endo-Surgery and Covidien, and he has received speaker fees and educational grants from Johnson & Johnson, Ethicon Endo- Surgery, Covidien and Stryker. No other competing interests declared.

Contributors: D.W. Birch, R.S. Gill and S. Karmali designed the study. M. El-Madi acquired and analyzed the data, which D.W. Birch and S. Karmali also analyzed. All authors wrote the article and reviewed and approved the final version for publication.

DOI: 10.1503/cjs.030612

Correspondence to: S. Karmali, Centre for the Advancement of, Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, 10240 Kingsway Ave. NW, Edmonton AB T5H 3V9; shahzeer@ualberta.ca