title: Effect of adjustable gastric banding on changes in gastroesophageal reflux disease (GERD) and quality of life.
abstract: OBJECTIVE
  Bariatric surgery is an effective treatment for the reduction of weight in obese patients (BMI ≥ 40 kg/m(2) or 30 kg/m(2) with ≥1 comorbidities), who are refractory to behavioral and medical therapies. This study examined the effect of the adjustable gastric band (AGB) system on changes in gastroesophageal reflux disease (GERD) and patient-reported outcomes, including measures of quality of life.
  
  
  METHODS
  Two-year interim analysis of patients (N = 171) in the 5 year, prospective APEX study who reported GERD prior to the AGB procedure. An unrecorded number of hiatal hernia repairs were conducted during the APEX study.
  
  
  RESULTS
  At baseline, 171 of 395 patients (43%) reported GERD requiring daily medical therapy. After 2 years, 122 patients had sufficient data to assess outcome (71%). Complete resolution of GERD was reported in 98 patients (80%), improvement in 13 (11%), no change in 9 (7%), and worsening in 2 (2%). Overall, 91% of GERD patients experienced resolution and/or improvement of GERD. Baseline BMI was not significantly different among the GERD response categories (resolved, improved, and stable/worse), p = 0.4581. Mean ΔBMI and percentage excess weight loss (%EWL) were: -8.8 kg/m(2)/-0.9%, -11.4 kg/m(2)/-53.9%, -6.4 kg/m(2)/-36.1%, and -7.1 kg/m(2)/-31.2%, respectively. There were no significant differences in reductions in BMI or %EWL between responder groups (resolved versus stable/worse ΔBMI p = 0.1031, %EWL p = 0.0667 OR resolved/improved versus stable/worse ΔBMI p = 0.0918, %EWL p = 0.0552). After 2 years, resolution or improvement occurred in pre-existing comorbidities: type 2 diabetes (96%), hypertension (91%), hyperlipidemia (77%), obstructive sleep apnea (86%), osteoarthritis (93%), and depression (75%). Patient satisfaction with AGB was assessed as: very satisfied/satisfied (87%), very satisfied (50%), dissatisfied (5.0%). Quality of life measured by the Obesity and Weight-Loss Quality of Life Instrument (GERD patients) significantly improved from baseline.
  
  
  CONCLUSIONS
  Obese patients with GERD had meaningful improvement in patient-reported outcomes with the AGB system. In addition, other obesity-related comorbidities and measures of quality of life improved.
authors.affiliation: Midsouth Bariatrics, Memphis, TN, USA.
authors.forename: George
authors.initials: G
authors.lastname: Woodman
authors.forename: Robert
authors.initials: R
authors.lastname: Cywes
authors.forename: Helmuth
authors.initials: H
authors.lastname: Billy
authors.forename: Kevin
authors.initials: K
authors.lastname: Montgomery
authors.forename: Christopher
authors.initials: C
authors.lastname: Cornell
authors.forename: Ted
authors.initials: T
authors.lastname: Okerson
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies