Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study

2021 ◽  
pp. 155335062110527
Author(s):  
Andrea Balla ◽  
Livia Palmieri ◽  
Diletta Corallino ◽  
Francesca Meoli ◽  
Maria Carlotta Sacchi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Erosive Esophagitis ◽  
Surgical Indication ◽  
Hrql Score ◽  
Demeester Score ◽  
Significant Difference ◽  
The Impact

Background To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LGB) on gastroesophageal reflux disease (GERD). Methods GERD was evaluated by the Modified Italian Gastroesophageal reflux disease—Health-Related Quality of Life (MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB. Results Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to 0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study, and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time, with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram findings in both groups. Conclusions LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD, to candidate them to LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical indication on objective grounds.

Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study

Endoscopy ◽  
2020 ◽  
Vol 52 (08) ◽  
pp. 643-651
Author(s):  
Zaheer Nabi ◽  
Mohan Ramchandani ◽  
Rama Kotla ◽  
Manu Tandan ◽  
Rajesh Goud ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Esophagitis ◽  
Reflux Disease ◽  
Comprehensive Evaluation ◽  
Erosive Esophagitis ◽  
Peroral Endoscopic Myotomy ◽  
Demeester Score ◽  
Endoscopic Myotomy

Abstract Background Gastroesophageal reflux disease (GERD) is an important concern after peroral endoscopic myotomy (POEM). However, there are limited data on the risk factors for post-POEM GERD and its responsiveness to proton pump inhibitors (PPIs). In this study, we aimed to analyze the variables affecting the occurrence of GERD and its response to PPI therapy. Methods Consecutive patients with idiopathic achalasia who underwent POEM (December 2016 to January 2018) were evaluated for GERD using 24-hour pH impedance, esophagogastroduodenoscopy (EGD), and symptoms. Multivariate analysis was performed to identify the variables affecting the incidence of post-POEM GERD. Results A total of 209 patients with esophageal motility disorders, including 194 patients with non-sigmoid achalasia, underwent POEM during the study period. Comprehensive evaluation of GERD was completed on 167 patients (86.1 %): 47.3 % women with a mean (standard deviation) age of 41 (14.42) years and body mass index of 22.2 (3.89) kg/m2; the majority (70.7 %) were treatment naïve. A high DeMeester score (> 14.72), reflux esophagitis, and symptomatic GERD were identified in 47.9 %, 41.9 %, and 29.3 % of patients, respectively. On logistic regression analysis, type of achalasia, technique of POEM (anterior vs. posterior), pre- or post-POEM esophageal manometry variables, and patient characteristics were not associated with post-POEM GERD. Erosive esophagitis responded to PPI therapy in the majority of patients (81.4 %). Conclusion The incidence of GERD is high after POEM. Most of the reflux esophagitis is mild and responsive to PPI therapy. There are no procedural or patient-related variables that appear to affect the incidence of post-POEM GERD.

Clinical observation of different anti-reflux methods in the treatment of gastroesophageal reflux disease with hiatus hernia

2021 ◽  
Author(s):  
Zhi-tong Li ◽  
Rui Zhang ◽  
Xin-wei Han ◽  
Chun-xia Li ◽  
Li Wang ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Postoperative Period ◽  
Hiatus Hernia ◽  
Reflux Disease ◽  
Operation Time ◽  
Control Group ◽  
Demeester Score ◽  
Significant Difference ◽  
Experimental Group

Abstract Hiatus hernia (HH) is a common benign disease of the digestive tract, which weaks the function of the anti-reflux barrier and causes gastroesophageal reflux disease (GERD). Laparoscopic HH repair and fundoplication is a classic surgical treatment for GERD patients with HH; however, some patients may complain of dysphagia and gas-bloating after the operation. For reducing complications of fundoplication, we adopted a new type of anti-reflux surgery for GERD treatment. We analysed our database of 40 patients with GERD plus HH who had LDF or a new anti-reflux surgery. At 12 months　after surgery, the total score(Sc), DeMeester score, numbers of reflux detected by impedance monitoring all decreased in two groups postoperatively, and there was no significant difference between the two groups after surgery. The minimum respiratory value increased after the operation in the control group, but there was no significant difference between the two groups. The mean respiratory value both increased in two groups postoperatively, and there was no significant difference between the two groups. The dysphagia in the experimental group was less common than that in the control group from early to 12 months after surgery. There was no significant difference in gas-bloating between the two groups in the early postoperative period but it was significantly lower in the experimental group than that in the control group in the late postoperative period. The short-term efficacy of the new anti-reflux surgery is the same as that of the LDP in the treatment of GERD with HH; however, the operation time, intraoperative blood loss, and the surgical complication rate are lower than that of the LDF, therefore, it is more commonly recommended.

scholarly journals Profile of the Change in Depression during Proton-Pump Inhibitor Therapy in Patients with Gastroesophageal Reflux Disease: Influence of the Mucosal Break

2021 ◽  
Vol 18 (11) ◽  
pp. 5964
Author(s):  
Chia-Liang Wu ◽  
Chien-Lin Chen ◽  
Shu-Hui Wen
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease ◽  
Proton Pump Inhibitor Therapy ◽  
Linear Regression Models ◽  
Independent Variable ◽  
The Difference ◽  
Mucosal Break ◽  
The Impact

Given the frequent concomitance between depression and gastroesophageal reflux disease (GERD), it is important to evaluate the change of depression in patients with GERD, especially considering the presence of esophageal mucosal breaks (MB). This study aimed to examine the change in the levels of depression in patients with GERD during proton-pump inhibitors (PPI) therapy. We designed a prospective cohort study to explore the profile of the alteration in depression with respect to the impact of esophageal MB. This study recruited 172 eligible patients with GERD between February 2016 and May 2018. The change in depression was defined as the difference between the respective Taiwanese Depression Questionnaire (TDQ) scores obtained at baseline and after PPI therapy. Multivariate linear regression models were used to estimate the factors associated with the change in depression. The results revealed statistically significant improvements in the TDQ score (mean score: baseline = 13.2, after PPI therapy = 10.9, p < 0.01, Cohen’s d = 0.30) during PPI therapy for GERD. Moreover, the MB was an independent variable associated with changes in the TDQ score [B = 3.31, 95% confidence interval (CI): (1.12, 5.51), p < 0.01] and the improvement in depression [odds ratio = 0.38, 95% CI: (0.17, 0.86), p = 0.02]. Our findings revealed that depressive symptoms improved slightly following PPI therapy. Moreover, MB was an unfavorable prognostic factor for the improvement in depression.

Impact of vertical sleeve gastrectomy on patients with preoperative gastroesophageal reflux disease

2016 ◽  
Vol 12 (7) ◽  
pp. S212-S213
Author(s):  
Jacqueline Paolino ◽  
Sajani Shah ◽  
Wesley Vosburg ◽  
Julie Kim ◽  
Adam Blau ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Vertical Sleeve Gastrectomy
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