Gastric bypass offers GERD benefits, too

Last Updated: 2015-02-02

By Reuters Staff

NEW YORK (Reuters Health) - In addition to causing significant weight loss, gastric bypass surgery appears to significantly reduce gastroesophageal reflux disease (GERD) symptoms and incidence in morbidly obese individuals long after the procedure, researchers in Brazil say.

Gastric bypass "improves GERD in objective and subjective analyses as many as 39 months after the operation," Dr. Carlos Augusto Scussel Madalosso, of the Department of Surgery at the University of Passo Fundo in Rio Grande do Sul, and colleagues wrote online January 20 in Annals of Surgery.

Previous research has found gastric bypass, the gold standard worldwide for treating severe obesity, to have a favorable effect on GERD on a short-term basis, including one study by this same group involving 86 patients evaluated for GERD six months after surgery.

To measure long-term outcomes, the Passo Fundo researchers enrolled 53 of those patients in this new study. The 15 men and 39 women, aged 18-59 years, had a mean body mass index (BMI) of 46 kg/m2. Of the original 83 patients, 15 were lost to follow-up and 18 refused additional exams.

The researchers evaluated patients for GERD before the operation, six months after and again 39 months after. They found that mean BMI dropped from 46 to 34 at six months to 30 at 39 months (p<0.001).

The prevalence of "typical reflux syndrome" decreased significantly from 31 patients (58%) at surgery to eight (15%) at six months and five (9%) at 39 months (p<0.001), the researchers write.

They evaluated the prevalence of GERD according to the Montreal Consensus, which classifies esophageal and esophageal syndromes based on troublesome symptoms or complications. Based on that, the researchers found, among other results, that:

- Troublesome heartburn declined from 29 (54%) patients at surgery to four (8%) at six months to three (6%) at 39 months (p<0.001);

- Troublesome regurgitation declined from 15 (28%) at surgery to five (9%) at six months to three (6%) at 39 months (p<0.001);

- Reflux esophagitis declined from 24 (45%) of patients at surgery to 17 (32%) at six months to 10 (19%) at 39 months (p=0.002); and

- GERD declined from 34 (64%) patients at surgery to 21 (40%) at six months to 12 (23%) at 39 months (p<0.001).

Apart from this not being a randomized trial, one study limitation is the number of patients lost to follow-up, the researchers write. However, they compared the final sample with characteristics of the ones lost to follow-up.

"We did not observe significant differences in the GERD prevalence, demographic parameters, or total acid exposure between the two groups," they write.

Further research will be needed to determine whether this benefit applies to people who need to lose less weight, they advise.

The researchers conclude, "In patients with a BMI of 40 kg/m2 or more or 35 kg/m2 or more combined with significant comorbidities and GERD, gastric bypass should be elected as the procedure of choice to resolve both obesity and GERD."

The authors report no external funding or disclosures.

SOURCE: http://bit.ly/18CnWSL

Ann Surg 2015.