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Management of Gastroesophageal Reflux Disease pp 167–173Cite as

Gastroesophageal Reflux Disease in Sleeve Gastrectomy: Pathophysiology and Available Treatments

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Abstract

Gastroesophageal reflux disease (GERD) is a common comorbidity in the obese population. Prevalence in the obese population is estimated to be around 37-72%. Therefore, GERD may be preexisting or may occur de novo after a bariatric operation. GERD results from a failure of normal anti-reflux barriers, centered around the esophagus, lower esophageal sphincter (LES), the crural portion of the hiatus, and the stomach. The pathophysiology behind obesity-related GERD appears to be the result of a multitude of anatomic and physiologic changes at the LES imposed by the central and visceral adiposity of obesity. Fundoplication has been considered the gold standard for surgical treatment of reflux disease. Beyond RYGB, laparoscopic sleeve gastrectomy (SG) has become the most popular primary bariatric operation, but not in the treatment of GERD. While sleeve gastrectomy has shown good results of excess weight loss, the high pressure system of a sleeve has shown mixed results or increased rate of GERD. The effects of SG on GERD symptoms is debated, with studies showing both improvement of GERD symptoms as well as worsening or even de novo development. Severe GERD following sleeve gastrectomy is a well-established complication. Preoperative predictors of severe reflux should be used to have an informed discussion with patients regarding their best options for primary bariatric surgical technique. Medical therapy remains the primary therapy in worsening or de novo GERD after sleeve gastrectomy; however, surgical techniques such as conversion to RYGB or MSA are safe and effective.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Sean M. Flynn & Ryan C. Broderick

  2. Department of Surgery, Center for the Future of Surgery, University of California San Diego, La Jolla, CA, USA

    Ryan C. Broderick

Authors
  1. Sean M. Flynn
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Correspondence to Ryan C. Broderick .

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Editors and Affiliations

  1. University of California, San Diego, Center for the Future of Surgery, La Jolla, CA, USA

    Santiago Horgan

  2. University of California, San Diego, Center for the Future of Surgery, La Jolla, CA, USA

    Karl-Hermann Fuchs

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Flynn, S.M., Broderick, R.C. (2020). Gastroesophageal Reflux Disease in Sleeve Gastrectomy: Pathophysiology and Available Treatments. In: Horgan, S., Fuchs, KH. (eds) Management of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_14

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  • DOI: https://doi.org/10.1007/978-3-030-48009-7_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48008-0

  • Online ISBN: 978-3-030-48009-7

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