Skip to main content

Advertisement

SpringerLink
Log in

GERD after Bariatric Surgery: A Review of the Underlying Causes and Recommendations for Management

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

GERD after bariatric surgery is an ongoing concern for bariatric surgeons and their patients. This paper reviews the association of persistent or de novo GERD after multiple types of bariatric surgery, and focuses on the work up and management of GERD after SG.

Recent Findings

Two recent large, multicenter randomized clinical trials have shown stronger associations between SG and GERD compared to RYGB. A large group of internationally recognized bariatric surgeons collaborated on 72 consensus statements to help guide the bariatric community on the subject of redo surgeries after SG, including as it pertains to GERD.

Summary

We present an algorithm that consolidates the best-practices recommendations of the work-up and management of GERD after sleeve gastrectomy, and mention areas of persistent controversy where future research is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

  1. Modern diagnosis of GERD: the Lyon Consensus | Gut. https://gut-bmj-com.ezproxy.library.wisc.edu/content/67/7/1351.long. Accessed 26 May 2023

  2. Ghosh SK. Biomechanics of the esophagogastric junction in gastroesophageal reflux disease. Curr Gastroenterol Rep. 2008;10:246–51. https://doi.org/10.1007/s11894-008-0051-6.

    Article  PubMed  Google Scholar 

  3. Eusebi LH, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018;67:430–40. https://doi.org/10.1136/gutjnl-2016-313589.

    Article  PubMed  Google Scholar 

  4. de Mello Del Grande L, Herbella FAM, Katayama RC, et al. Transdiaphragmatic Pressure Gradient (TPG) Has a Central Role in the Pathophysiology of Gastroesophageal Reflux Disease (GERD) in the Obese and it Correlates with Abdominal Circumference but Not with Body Mass Index (BMI). Obes Surg. 2020;30:1424–8. https://doi.org/10.1007/s11695-019-04345-x.

    Article  PubMed  Google Scholar 

  5. Park S-K, Lee T, Yang H-J, et al (2017) Weight loss and waist reduction is associated with improvement in gastroesophageal disease reflux symptoms: A longitudinal study of 15 295 subjects undergoing health checkups. Neurogastroenterol Motil. 29:. https://doi.org/10.1111/nmo.13009

  6. Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Weight loss and reduction in gastroesophageal reflux. A prospective population-based cohort study: the HUNT study. Am J Gastroenterol. 2013;108:376–82. https://doi.org/10.1038/ajg.2012.466.

    Article  PubMed  Google Scholar 

  7. Slater BJ, Collings A, Dirks R, et al. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc. 2023;37:781–806. https://doi.org/10.1007/s00464-022-09817-3.

    Article  PubMed  Google Scholar 

  8. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs 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. https://doi.org/10.1001/jama.2017.20897.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Salminen P, Grönroos S, Helmiö M, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA Surg. 2022;157:656–66. https://doi.org/10.1001/jamasurg.2022.2229.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Felinska E, Billeter A, Nickel F, et al. Do we understand the pathophysiology of GERD after sleeve gastrectomy? Ann N Y Acad Sci. 2020;1482:26–35. https://doi.org/10.1111/nyas.14467.

    Article  PubMed  Google Scholar 

  11. Braghetto I, Lanzarini E, Korn O, et al. Manometric Changes of the Lower Esophageal Sphincter After Sleeve Gastrectomy in Obese Patients. Obes Surg. 2010;20:357–62. https://doi.org/10.1007/s11695-009-0040-3.

    Article  PubMed  Google Scholar 

  12. Mejía-Rivas MA, Herrera-López A, Hernández-Calleros J, et al. Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass. Obes Surg. 2008;18:1217–24. https://doi.org/10.1007/s11695-008-9474-2.

    Article  PubMed  Google Scholar 

  13. Swartz DE, Mobley E, Felix EL. Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain. Surg Obesity Relate Dis. 2009;5:27–30. https://doi.org/10.1016/j.soard.2008.10.009.

    Article  Google Scholar 

  14. Salimath J, Rosenthal RJ, Szomstein S. Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula. Surg Endosc. 2009;23:2591–5. https://doi.org/10.1007/s00464-009-0465-8.

    Article  PubMed  Google Scholar 

  15. 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. https://doi.org/10.1007/s11695-019-04292-7.

    Article  PubMed  Google Scholar 

  16. Jaruvongvanich V, Osman K, Matar R, et al. Impact of bariatric surgery on surveillance and treatment outcomes of Barrett’s esophagus: A stage-matched cohort study. Surg Obes Relat Dis. 2021;17:1457–64. https://doi.org/10.1016/j.soard.2021.04.018.

    Article  PubMed  Google Scholar 

  17. Clapp B, Ponce J, DeMaria E, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2022;18:1134–40. https://doi.org/10.1016/j.soard.2022.06.284.

    Article  PubMed  Google Scholar 

  18. Badaoui JN, Kellogg TA, Abu Dayyeh BK, et al. The Outcomes of Laparoscopic Biliopancreatic Diversion with Duodenal Switch on Gastro-esophageal Reflux Disease: the Mayo Clinic Experience. Obes Surg. 2021;31:4363–70. https://doi.org/10.1007/s11695-021-05581-w.

    Article  PubMed  Google Scholar 

  19. Souza RF, Krishnan K, Spechler SJ. Acid, bile, and CDX: the ABCs of making Barrett’s metaplasia. Am J Physiol Gastrointest Liver Physiol. 2008;295:G211-218. https://doi.org/10.1152/ajpgi.90250.2008.

    Article  CAS  PubMed  Google Scholar 

  20. Andalib A, Bouchard P, Alamri H, et al. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study. Surg Obes Relat Dis. 2021;17:414–24. https://doi.org/10.1016/j.soard.2020.09.015.

    Article  PubMed  Google Scholar 

  21. Admella V, Osorio J, Sorribas M, et al. Direct and two-step single anastomosis duodenal switch (SADI-S): Unicentric comparative analysis of 232 cases. Cir Esp (Engl Ed). 2021;99:514–20. https://doi.org/10.1016/j.cireng.2021.06.017.

    Article  PubMed  Google Scholar 

  22. Lee W-J, Lin Y-H. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24:1749–56. https://doi.org/10.1007/s11695-014-1369-9.

    Article  PubMed  Google Scholar 

  23. Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. The Lancet. 2019;393:1299–309. https://doi.org/10.1016/S0140-6736(19)30475-1.

    Article  Google Scholar 

  24. Salman MA, Abelsalam A, Nashed GA, et al. Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: a Randomized Controlled Study. Obes Surg. 2023;33:1966–73. https://doi.org/10.1007/s11695-023-06631-1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Level L, Rojas A, Piñango S, Avariano Y. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial. Langenbecks Arch Surg. 2021;406:171–9. https://doi.org/10.1007/s00423-020-01949-1.

    Article  PubMed  Google Scholar 

  26. Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022;400:441–51. https://doi.org/10.1016/S0140-6736(22)01280-6.

    Article  PubMed  Google Scholar 

  27. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2018 Oct 11 - . Identifier NCT03705416, Long Term Outcomes of Bariatric Patients Treated With Surgery or Endoscopy (ROSE); 2023 Nov 18 [cited 2023 Nov 7]; [about 12 screens]. Available from: https://clinicaltrials.gov/study/NCT03705416

  28. Campos GM, Mazzini GS, Altieri MS, et al. ASMBS position statement on the rationale for performance of upper gastrointestinal endoscopy before and after metabolic and bariatric surgery. Surg Obes Relat Dis. 2021;17:837–47. https://doi.org/10.1016/j.soard.2021.03.007.

    Article  PubMed  Google Scholar 

  29. Brown WA, Johari Halim Shah Y, Balalis G, et al. IFSO Position Statement on the Role of Esophago-Gastro-Duodenal Endoscopy Prior to and after Bariatric and Metabolic Surgery Procedures. Obes Surg. 2020;30:3135–53. https://doi.org/10.1007/s11695-020-04720-z.

    Article  PubMed  Google Scholar 

  30. Kermansaravi M, Parmar C, Chiappetta S, et al. Best practice approach for redo-surgeries after sleeve gastrectomy, an expert’s modified Delphi consensus. Surg Endosc. 2023;37:1617–28. https://doi.org/10.1007/s00464-023-09879-x.

    Article  PubMed  Google Scholar 

  31. El Nakeeb A, Aldossary H, Zaid A, et al. Prevalence, Predictors, and Management of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy: a Multicenter Cohort Study. Obes Surg. 2022;32:3541–50. https://doi.org/10.1007/s11695-022-06264-w.

    Article  PubMed  Google Scholar 

  32. Golas A, El-Attrache B-FM, Jorge J, et al. Repair of post-bariatric surgery, recurrent, and de novo hiatal hernias improves bloating, abdominal pain, regurgitation, and food intolerance. Surg Obes Relat Dis. 2021;17:683–91. https://doi.org/10.1016/j.soard.2020.12.006.

    Article  PubMed  Google Scholar 

  33. Soong T-C, Almalki OM, Lee W-J, et al. Revision of Sleeve Gastrectomy with Hiatal Repair with Gastropexy for Gastroesophageal Reflux Disease. Obes Surg. 2019;29:2381–6. https://doi.org/10.1007/s11695-019-03853-0.

    Article  PubMed  Google Scholar 

  34. Runkel A, Scheffel O, Marjanovic G, et al. Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery. Obes Surg. 2021;31:1422–30. https://doi.org/10.1007/s11695-020-05153-4.

    Article  PubMed  Google Scholar 

  35. Patel SH, Smith B, Polak R, et al. Laparoscopic magnetic sphincter augmentation device placement for patients with medically-refractory gastroesophageal reflux after sleeve gastrectomy. Surg Endosc. 2022;36:8255–60. https://doi.org/10.1007/s00464-022-09261-3.

    Article  PubMed  Google Scholar 

  36. Broderick RC, Smith CD, Cheverie JN, et al. Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery. Surg Endosc. 2020;34:3211–5. https://doi.org/10.1007/s00464-019-07096-z.

    Article  PubMed  Google Scholar 

  37. Khaitan L, Hill M, Michel M, et al. Feasibility and Efficacy of Magnetic Sphincter Augmentation for the Management of Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy for Obesity. Obes Surg. 2023;33:387–96. https://doi.org/10.1007/s11695-022-06381-6.

    Article  PubMed  Google Scholar 

  38. Khidir N, Angrisani L, Al-Qahtani J, et al. Initial Experience of Endoscopic Radiofrequency Waves Delivery to the Lower Esophageal Sphincter (Stretta Procedure) on Symptomatic Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy. Obes Surg. 2018;28:3125–30. https://doi.org/10.1007/s11695-018-3333-6.

    Article  PubMed  Google Scholar 

  39. Rodríguez L, Rodriguez PA, Gómez B, et al. Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: long-term 3-year results. Surg Endosc. 2016;30:2666–72. https://doi.org/10.1007/s00464-015-4539-5.

    Article  PubMed  Google Scholar 

  40. Borbély Y, Bouvy N, Schulz HG, et al. Electrical stimulation of the lower esophageal sphincter to address gastroesophageal reflux disease after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14:611–5. https://doi.org/10.1016/j.soard.2018.02.006.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Irene S. Yu, MD, for her rendering of bariatric anatomy for Figure 1.

Author information

Authors and Affiliations

  1. Department of Surgery, University at Buffalo, 100 High Street, Buffalo, NY, D35014203, USA

    Alison Pletch

  2. Division of Minimally Invasive Surgery, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53726, USA

    Anne Lidor

Authors
  1. Alison Pletch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Lidor
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.P. and A.L collaborated on the content of the manuscript. A.P wrote the main manuscript text and prepared Fig. 2. A.L. reviewed the manuscript and revised it for intellectual content.

Corresponding author

Correspondence to Alison Pletch.

Ethics declarations

Declarations

This article does not contain any studies with human or animal subjects performed by.

any of the authors.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pletch, A., Lidor, A. GERD after Bariatric Surgery: A Review of the Underlying Causes and Recommendations for Management. Curr Gastroenterol Rep 26, 99–106 (2024). https://doi.org/10.1007/s11894-024-00919-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-024-00919-7

Keywords

Search

Navigation