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Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation.
Ann Surg. 2014 Nov; 260(5):909-14; discussion 914-5.AnnS

Abstract

OBJECTIVE

To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) in morbidly obese patients.

BACKGROUND

Symptomatic GERD is considered by many a contraindication to LSG. However, studies evaluating the relationship between LSG and GERD by 24-hour pH monitoring are lacking.

METHODS

Consecutive morbidly obese patients selected for LSG were included in a prospective clinical study. Gastroesophageal function was evaluated using a clinical validated questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring before and 24 months after LSG. This trial is registered with ClinicalTrials.gov (no. NCT02012894).

RESULTS

From June 2009 to September 2011, a total of 71 patients were enrolled into the study; 65 (91.5%) completed the 2-year protocol. On the basis of preoperative 24-hour pH monitoring, patients were divided into group A (pathologic, n=28) and group B (normal, n=37). Symptoms improved in group A, with the Gastroesophageal Reflux Disease Symptom Assessment Scale score decreasing from 53.1±10.5 to 13.1±3.5 (P<0.001). The DeMeester score and total acid exposure (% pH<4) decreased in group A patients (DeMeester score from 39.5±16.5 to 10.6±5.8, P<0.001; % pH<4 from 10.2±3.7 to 4.2±2.6, P<0.001). Real "de novo" GERD occurred in 5.4% group B patients. No significant changes in lower esophageal sphincter pressure and esophageal peristalsis amplitude were found in both groups.

CONCLUSIONS

LSG improves symptoms and controls reflux in most morbidly obese patients with preoperative GERD. In obese patients without preoperative evidence of GERD, the occurrence of "de novo" reflux is uncommon. Therefore, LSG should be considered an effective option for the surgical treatment of obese patients with GERD.

Authors+Show Affiliations

From the Department of Surgical Sciences, University of Torino, Turin, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25379861

Citation

Rebecchi, Fabrizio, et al. "Gastroesophageal Reflux Disease and Laparoscopic Sleeve Gastrectomy: a Physiopathologic Evaluation." Annals of Surgery, vol. 260, no. 5, 2014, pp. 909-14; discussion 914-5.
Rebecchi F, Allaix ME, Giaccone C, et al. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260(5):909-14; discussion 914-5.
Rebecchi, F., Allaix, M. E., Giaccone, C., Ugliono, E., Scozzari, G., & Morino, M. (2014). Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Annals of Surgery, 260(5), 909-14; discussion 914-5. https://doi.org/10.1097/SLA.0000000000000967
Rebecchi F, et al. Gastroesophageal Reflux Disease and Laparoscopic Sleeve Gastrectomy: a Physiopathologic Evaluation. Ann Surg. 2014;260(5):909-14; discussion 914-5. PubMed PMID: 25379861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. AU - Rebecchi,Fabrizio, AU - Allaix,Marco E, AU - Giaccone,Claudio, AU - Ugliono,Elettra, AU - Scozzari,Gitana, AU - Morino,Mario, PY - 2014/11/8/entrez PY - 2014/11/8/pubmed PY - 2015/4/2/medline SP - 909-14; discussion 914-5 JF - Annals of surgery JO - Ann. Surg. VL - 260 IS - 5 N2 - OBJECTIVE: To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) in morbidly obese patients. BACKGROUND: Symptomatic GERD is considered by many a contraindication to LSG. However, studies evaluating the relationship between LSG and GERD by 24-hour pH monitoring are lacking. METHODS: Consecutive morbidly obese patients selected for LSG were included in a prospective clinical study. Gastroesophageal function was evaluated using a clinical validated questionnaire, upper endoscopy, esophageal manometry, and 24-hour pH monitoring before and 24 months after LSG. This trial is registered with ClinicalTrials.gov (no. NCT02012894). RESULTS: From June 2009 to September 2011, a total of 71 patients were enrolled into the study; 65 (91.5%) completed the 2-year protocol. On the basis of preoperative 24-hour pH monitoring, patients were divided into group A (pathologic, n=28) and group B (normal, n=37). Symptoms improved in group A, with the Gastroesophageal Reflux Disease Symptom Assessment Scale score decreasing from 53.1±10.5 to 13.1±3.5 (P<0.001). The DeMeester score and total acid exposure (% pH<4) decreased in group A patients (DeMeester score from 39.5±16.5 to 10.6±5.8, P<0.001; % pH<4 from 10.2±3.7 to 4.2±2.6, P<0.001). Real "de novo" GERD occurred in 5.4% group B patients. No significant changes in lower esophageal sphincter pressure and esophageal peristalsis amplitude were found in both groups. CONCLUSIONS: LSG improves symptoms and controls reflux in most morbidly obese patients with preoperative GERD. In obese patients without preoperative evidence of GERD, the occurrence of "de novo" reflux is uncommon. Therefore, LSG should be considered an effective option for the surgical treatment of obese patients with GERD. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/25379861/Gastroesophageal_reflux_disease_and_laparoscopic_sleeve_gastrectomy:_a_physiopathologic_evaluation_ L2 - http://Insights.ovid.com/pubmed?pmid=25379861 DB - PRIME DP - Unbound Medicine ER -