Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function.
Obesity and gastroesophageal reflux disease (GERD) are commonly associated diseases. Bariatric surgery has been shown to have various impacts on esophageal function and GERD. Our aim was to evaluate changes in symptoms, endoscopic findings, bolus passage and esophageal function in patients after primary gastric bypass surgery as compared to patients converted from gastric banding to gastric bypass.



Obese patients scheduled for laparoscopic Roux-en-Y gastric bypass (naïve-to-bypass) and patients who previously underwent gastric banding and were considered for conversion from gastric banding to gastric bypass (band-to-bypass) were included. Patients rated esophageal and epigastric symptoms (100 point VAS) and underwent upper endoscopy, impedance-manometry, and modified "timed barium swallow" before/after surgery.



Data from 66 naïve-to-bypass patients (51/66, 77 % females, mean age 41.2 ± 11.1 years) and 68 band-to-bypass patients (53/68, 78 % females, mean age 43.8 ± 10.0 years) were available for analysis. Esophageal symptoms, esophagitis, esophageal motility abnormalities and impaired esophageal bolus transit were more common in patients that underwent gastric banding compared to those that underwent gastric bypass. The majority of symptoms, lesions and abnormalities induced by gastric banding were decreased by conversion to gastric bypass. Esophagitis was present in 28/68 (41 %) and 13/47 (28 %) patients in the band-to-bypass group, pre- versus postoperatively, respectively, (p < 0.05). The percentage of swallows with normal bolus transit increased following transformation from gastric band to gastric bypass (57.9 ± 4.1 and 83.6 ± 3.4 %, respectively, p < 0.01).



From an esophageal perspective, gastric bypass surgery induces less motility disorders and esophageal symptoms and should be therefore favored over gastric banding in difficult to treat obese patients at risk of repeated bariatric surgery.
Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.
Jan
J
Borovicka
Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.
Claudia
C
Krieger-Grübel
Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.
Boudewijn
B
van der Weg
Hirslanden Clinic, 9016, St. Gallen, Switzerland.
Martin
M
Thurnheer
Hirslanden Clinic, 9016, St. Gallen, Switzerland.
Bernd
B
Schultes
Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.
Michael Christian
MC
Sulz
Private Gastroenterology Practice, 8800, Thalwil, Switzerland.
Jean-Pierre
JP
Gutzwiler
Hirslanden Clinic, 9016, St. Gallen, Switzerland.
Philipp
P
Bisang
Division of Gastroenterology, University Hospital Zurich, 8091, Zurich, Switzerland.
Daniel
D
Pohl
Division of Gastroenterology, University Hospital Zurich, 8091, Zurich, Switzerland.
Michael
M
Fried
Division of Gastroenterology, Kantonsspital St. Gallen, 9001, St. Gallen, Switzerland.
Christa
C
Meyenberger
Division of Gastroenterology, University Hospital Zurich, 8091, Zurich, Switzerland. radu.tutuian@insel.ch.|Division of Gastroenterology, University Clinics for Visceral Surgery and Medicine, Bern University Hospital, 3010, Bern, Switzerland. radu.tutuian@insel.ch.
Radu
R
Tutuian
D000328:Adult; D000368:Aged; D000071041:Esophageal Mucosa / Q000000981:diagnostic imaging / Q000503:physiopathology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome
Bariatric surgery; Endoscopy; Impedance–manometry; Obesity