Prognosis of Reflux Symptom Resolution After Bariatric Surgery: How Can Preoperative Esophageal Testing Help?

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Gastroesophageal reflux disease (GERD) can persist or develop after bariatric surgery.
• Predicting which patients will experience unresolved reflux post-surgery is challenging.
• Preoperative esophageal function testing may offer insights into predicting postoperative reflux.

Purpose of the Study:

• To identify preoperative predictors of unresolved reflux one year after bariatric surgery.
• To compare the incidence of unresolved reflux between vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB).
• To investigate the role of esophageal manometry and pH testing in predicting postoperative reflux.

Main Methods:

• Retrospective review of adult patients undergoing VSG or RYGB with preoperative reflux symptoms (2015-2021).
• All patients underwent preoperative pH monitoring and high-resolution manometry.
• Statistical analysis included Fisher's exact test, Kruskal Wallis test, and univariate logistic regression to identify predictors of unresolved reflux.

Main Results:

• Unresolved reflux occurred more frequently after VSG (46.5%) compared to RYGB (19.4%).
• In RYGB patients, ineffective esophageal motility (IEM) was significantly higher in those with unresolved reflux (31.6% vs. 8.9%, p=0.01).
• VSG patients with unresolved reflux reported more preoperative dysphagia (13.3% vs. 2.9%, p=0.04) and higher proton pump inhibitor (PPI) use (56.7% vs. 39.1%, p=0.05).

Conclusions:

• Vertical sleeve gastrectomy is associated with a higher incidence of unresolved postoperative reflux compared to Roux-en-Y gastric bypass.
• Preoperative ineffective esophageal motility is a significant predictor of unresolved reflux following RYGB.
• Preoperative dysphagia and PPI use in VSG patients suggest subjective symptom reporting may predict reflux, despite a lack of correlation with objective testing.