Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient
Journal of Laparoendoscopic&Advanced Surgical Techniques , Vol. 0, No. 0.
AbstractThe development of achalasia in patients with a prior Roux-en-Y gastric bypass (RYGB) is rare and it often remains unclear whether the esophageal motility disorder is a pre-existing condition in the obese patient or develops de novo after the procedure. The aim of this study was to review the available evidence regarding the management of patients with achalasia after a RYGB. Intra-sphincteric injection of botulinum toxin and pneumatic dilatation can be used to eliminate the functional obstruction at the level of the gastroesophageal junction. However, considering that achalasia patients after RYGB are often young ...
AbstractThe purpose of this study was to investigate the relationship between bariatric surgery (laparoscopic sleeve gastrectomy [LSG] and laparoscopic Roux-en-Y gastric bypass [LRYGB]) and gastroesophageal reflux disease (GERD). The number of obese patients with newly onset, worsened, or improved GERD after bariatric surgery in each article were extracted. In the pooled analysis, LSG was associated with a higher risk of GERD than LRYGB (odds ratio [OR] = 5.10, 95% confidence interval [CI] 3.60 –7.23,p
AbstractIntroductionBariatric surgery is increasingly performed. Since there are numerous surgical techniques, the effects of these on the esophageal function are still poorly understood. We aimed at assessing the effect of different techniques on esophagogastric junction (EGJ), esophageal peristalsis and reflux exposure using high-resolution manometry (HRM), and impedance-pH monitoring (MII-pH).MethodsAll obese patients underwent symptomatic questionnaires, endoscopy, HRM, and MII-pH before and 1 year after surgery. Esophageal function and EGJ were classified according to Chicago Classification V. 3.0. Intragastric ...
Conclusions:The absence of demographic or clinical predictors of OSA supports using general indications for PSG in children with ASD.Citation:Tomkies A, Johnson RF, Shah G, Caraballo M, Evans P, Mitchell RB. Obstructive sleep apnea in children with autism.J Clin Sleep Med. 2019;15(10):1469–1476.
We read with interest the recent article by Perotin et al. , which investigated epithelial dysregulation in obese severe asthma patients with gastro-oesophageal reflux. The researchers found that bronchial epithelial gene expression, sampled by airway brushing, identified an endotype defined by epithelial dysregulation associated with obesity, gastro-oesophageal reflux and use of proton pump inhibitors (OGP cluster). Relative to non-asthmatic healthy controls, pathway signature analysis indicated that the wingless tail (WNT)/β-catenin pathway was the top epithelial pathway dysregulated in the OGP cluster. The clust...
Gastroesophageal reflux disease (GERD) has a reported incidence of between 10% and 20% in Western populations with an even higher incidence in populations with obesity . The vast majority of patients are managed medically with surgical intervention undertaken in those with recalcitrant GERD. Populations with obesity and recalcitrant GERD who are interested in weight loss surgery have historically undergone laparoscopic Roux-en-Y gastric bypass (LRYGB). De Goot et al. , in their 2009 meta-analysis, demonstrated improvement in GERD in people with obesity after LRYGB.
Gastroesophageal reflux disease (GERD) has a reported incidence of between 10 to 20% in western populations with an even higher incidence in populations with obesity (1). The vast majority of patients are managed medically with surgical intervention undertaken in those with recalcitrant GERD. Populations with obesity and recalcitrant GERD who are interested in weight loss surgery have historically undergone Laparoscopic Roux En Y Gastric Bypass (LRYGB). De Goot et al in their 2009 meta-analysis demonstrated improvement in GERD in people with obesity following LRYGB(2).
ConclusionEE is more prevalent after SG compared with RYGB in a pre-bariatric surgery cohort with GERD. SG is associated with significant esophageal physiologic changes conducive to GERD and its clinical consequences.
ConclusionsPatients submitted to LSG showed a significant and progressive increase in the presence of “de novo” GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a “pro-reflux” surgical procedure, which should be continuously evaluated late after surgery.
Persistent Gastro-esophageal reflux symptoms for more than 4ys in spite of different medical treatment with persistent endoscopic signs of reflux esophagitis and gastritis especially in patient with BMI> 35 kg/m2 need special concern when seek for surgical management of obesity. Laparoscopic Roux-en-Y gastric bypass has been reported to be the most effective and less debatable option for effective treatment of morbid obesity with persistent GERD (Gastro-esophageal reflux disease). It may be associated with antireflux surgery or not.