Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study.

BACKGROUND: Evolution of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) is controversial. Some authors report worsening or improvement of preoperative GERD, others the occurrence of de novo GERD between 5 and 69%.

AIMS: The aims of this study are to evaluate the evolution of GERD after SG by ambulatory 24-h pH monitoring (APM) and to determine pre- and postoperative clinical and manometric factors associated with its evolution.

METHODS: Between 2013 and 2015, 47 patients operated in our center performed APM before and 1 year (14.8 ± 4.9 months) after SG. GERD was defined as a percentage of time with esophageal pH < 4 (TpH < 4) > 4.2. Among them, 30 had pre- and postoperative high-resolution esophageal manometry (HRM).

RESULTS: Thirty-one patients (66%) had no preoperative GERD (group 1), and 16 had preoperative GERD (group 2). One year after SG, mean TpH < 4 increased significantly in group 1 (5.8 ± 4.6 vs. 1.8 ± 1.1%, p < 0.01) whereas it was not modified in group 2 (7.4 ± 6.6 vs. 6.6 ± 2.6%). In group 1, 16 patients (52%) had de novo GERD whereas in group 2, 7 had no more GERD, 3 improved, and 6 worsened. Maximal intragastric pressure after swallows increased significantly at postoperative HRM only in patients with de novo GERD (49.2 ± 22.0 vs. 25.4 ± 9.4 mmHg, p = 0.03). No preoperative clinical or manometric parameters were predictive of postoperative GERD.

CONCLUSIONS: One year after SG, esophageal acid exposure globally worsened, mostly because of de novo GERD, whereas 63% patients with preoperative GERD improved, without preoperative predictive clinical or manometric factor.