Does GERD Improve or Worsen After Bariatric Surgery?

November 9, 2019

By Louise Gagnon

LAS VEGAS -- November 8, 2019 -- Patients with gastroesophageal reflux disease (GERD) who undergo gastric bypass have significant less reflux symptoms compared with patients who undergo sleeve gastrectomy, according to a study presented here at Obesity Week 2019.

“GERD symptoms are very common and obesity is a risk factor [for GERD],” said Oliver Varban, MD, University of Michigan, Ann Arbor, Michigan. “Bariatric surgery can improve symptoms. However, more recent data suggest that sleeve gastrectomy can worsen symptoms or result in new-onset of symptoms.”

For the study, the researchers looked at data from a state-wide bariatric-specific registry and included 10,554 patients who completed a survey about GERD symptoms at baseline and at 1 year after bariatric surgery, comparing the effect of surgery on symptoms after either form of bariatric surgery.

Results showed no significant difference in overall improvement of reflux symptoms between patients in the gastric bypass group and sleeve gastrectomy group (30.4% vs 30.8% ; respectively; P = .7015).

Patients who had a baseline score of 1 to 4 in reflux symptoms had a significantly higher likelihood of lessening in symptoms after gastric bypass than sleeve gastrectomy (P

“Our findings showed that the vast majority of patients either have similar symptoms or an improvement after surgery,” said Dr. Varban. “Gastric bypass was superior to sleeve gastrectomy, in that patients were more likely to have improvement in symptoms, regardless of how bad their symptoms were at baseline.”

The researchers found that patients who had no baseline symptoms were more at risk of developing new onset symptoms 1 year after surgery if they underwent sleeve gastrectomy instead of gastric bypass (21.0% vs 7.6%; P

Another finding was that baseline severity of symptoms was not associated with the type of surgery.

“We found that patients with no symptoms at baseline had a 21% chance of developing symptoms at 1 year after sleeve gastrectomy, which was much higher than gastric bypass,” said Dr. Varban.

While the study offered robustness in terms of the number of patients included, it did have some limitations.

“These data do not include objective evidence of gastroesophageal reflux that you can get from pH probe testing or endoscopy,” said Dr. Varban. “They also do not take into account the variation in operative technique, which may play a role in how likely one is to develop reflux symptoms. We plan on evaluating that with subsequent studies.”

Obesity Week is sponsored by the American Society for Metabolic & Bariatric Surgery and the Obesity Society.

[Presentation title: Better or Worse? a State-Wide Analysis of Patient-reported Reflux Symptoms Before and After Bariatric Surgery]