title: Impact of sleeve gastrectomy on gastroesophageal reflux disease in a morbidly obese population undergoing bariatric surgery.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) has established popularity as a weight loss procedure based on its success. However, LSG's effect on gastroesophageal reflux disease (GERD) is unknown.
  
  
  OBJECTIVE
  To analyze the incidence of GERD after LSG and to compare the results in patients with preexisting and de novo GERD.
  
  
  METHODS
  Tertiary Medical center.
  
  
  METHODS
  The authors performed a retrospective review of primary LSG from 2005 to 2013 and compared patients with pre-existing and de novo GERD who underwent LSG.
  
  
  RESULTS
  A total of 919 patients underwent LSG. GERD was present in 38 (4%) of the LSG cohort. We identified 2 groups: Group A consisted of 25 (3%) patients with de novo GERD, and Group B consisted of 13 (1%) patients with pre-existing GERD. Diagnosis of GERD in both groups was determined by symptoms and history of proton pump inhibitor (PPI) treatment, upper gastrointestinal endoscopy, esophagogastroduodenoscopy, and pH manometry. In Group A, 1 (4%) patient was managed with over-the-counter drugs, 17 (68%) patients were treated with low-dose PPI, 6 (24%) patients were treated with high-dose PPI, and 1 (4%) patient was lost to follow-up. Group B consisted of 9 (69%) patients treated with low-dose PPI and 4 (31%) patients treated with high-dose PPI. Medical treatment failed in 4 patients (10.5%) who subsequently required conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB). In Group A, 1 patient (4%) required LRYGB, and in Group B, 3 patients (23%) required LRYGB. The outcome of conversion for Group A was incomplete resolution of symptoms in the 1 patient, whereas in Group B, all 3 patients (100%) had complete resolution of GERD symptoms after LRYGB.
  
  
  CONCLUSIONS
  In this study, 3% of patients developed de novo GERD, but most responded to either low- or high-dose PPI, with 4% requiring conversion to LRYGB.
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
authors.forename: LéShon
authors.initials: L
authors.lastname: Hendricks
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Alvarenga
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Nisha
authors.initials: N
authors.lastname: Dhanabalsamy
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, Florida. Electronic address: Rosentr@ccf.org.
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D016145:Endoscopy, Digestive System; D016099:Endoscopy, Gastrointestinal; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass / Q000379:methods; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology*; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008365:Manometry; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastrectomy; Gastroesophageal; Gastroesophageal reflux disease; Reflux; Sleeve