Pathophysiological Mechanisms of Gastro-esophageal Reflux After Sleeve Gastrectomy

Objective: To evaluate the mechanisms associated with reflux events after sleeve gastrectomy (SG). Summary Background Data: Gastro-esophageal reflux (GERD) post-SG is a critical issue due to symptom severity, impact on quality of life, requirement for reoperation, and potential for Barrett esophagus. The pathophysiology is incompletely delineated. Methods: Post-SG patients, stratified into asymptomatic and symptomatic, underwent protocolized nuclear scintigraphy (n = 83), 24-hour esophageal pH monitoring, and stationary manometry (n = 143) to characterize reflux patterns. Ten patients underwent fasting and postprandial concurrent manometry and pH for detailed analysis of reflux events. Results: Baseline demographics between cohorts were similar: Age 47.2 ± 11.6 versus 44.1 ± 11.3 years (P = 0.121); females 73.2% versus 90.8% (P = 0.005); excess weight loss 53.8 ± 28.1% versus 57.4 ± 25.5% (P = 0.422), follow-up duration 12.3 versus 7.4 months (P = 0.503). Nuclear scintigraphy delineated bolus-induced deglutitive reflux events (29.6% vs 62.5%, P = 0.005) and postprandial reflux events [4 (IQR2) versus 4 (IQR 3) events, P = 0.356]. Total acid exposure was significantly elevated in the symptomatic population (7.7% vs 3.6%, P
Source: Annals of Surgery - Category: Surgery Tags: Original Articles Source Type: research