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Gastric Sleeve Little Help For GERD

Thu, 02/06/2014 - 10:09am
Crystal Phend

Gastric bypass surgery usually resolved comorbid gastroesophageal reflux disease (GERD), whereas laparoscopic sleeve gastrectomy did not and actually led to some new onset heartburn, a national database showed.

The rate of GERD resolution was 63 percent within 6 months after gastric bypass compared with 16 percent after the gastric sleeve procedure (P<0.001), Matthew J. Martin, MD, of Madigan Army Medical Center in Tacoma, Wash., and colleagues found.

Of people without GERD before their bariatric surgery, 9 percent developed it after sleeve gastrectomy, the researchers reported online in JAMA Surgery.

Together with similar evidence from prior small case series, "this information should be taken into consideration during patient counseling and selection of the optimal bariatric procedure," the group suggested.

They recommended evaluating all bariatric surgery candidates for the presence and severity of GERD.

"Although there is no definitive evidence to support the listing of GERD as an absolute contraindication to laparoscopic sleeve gastrectomy," they wrote, "the available data suggest that the presence of pre-existing severe GERD or esophageal dysmotility may be considered a relative contraindication."

That procedure has been increasingly popular, they noted, raising concerns given the high comorbidity rate in obesity.

In the retrospective study, GERD was present in 45 percent of the 4,832 patients who got a gastric sleeve and 50 percent of the 33,867 who had gastric bypass as recorded in the national Bariatric Outcomes Longitudinal Database, a repository connected to centers of excellence certification.

Presence of GERD wasn't linked to weight loss after gastric bypass, but was associated with less weight loss after sleeve gastrectomy, "likely due to alterations in dietary intake, such as substituting higher calorie and carbohydrate liquid foods for higher protein solid foods, and decreasing activity level due to pain and reflux symptoms."

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