title: Increased Esophageal Exposure to Weakly Acidic Reflux 5 Years After Laparoscopic Roux-en-Y Gastric Bypass.
abstract: OBJECTIVE
  To evaluate the long-term effects of laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on gastroesophageal function.
  
  
  BACKGROUND
  LRYGB is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GERD). However, long-term instrumental evaluations of GERD after LRYGB are not available.
  
  
  METHODS
  Morbidly obese patients selected for LRYGB were included in a prospective study. We performed clinical evaluation with GERD-HRQoL questionnaire, upper endoscopy, esophageal manometry, and 24-hour impedance pH (24-hour MII-pH) monitoring preoperatively and at 12 and 60 months after surgery. This trial is registered with ClinicalTrials.gov (no. NCT02618044).
  
  
  RESULTS
  From May 2006 to May 2009, 86 patients entered the study and 72 (84%) completed the 5-year protocol. At preoperative 24-hour MII-pH monitoring, 54 patients (group A) had normal values, whereas 32 (group B) had diagnosis of GERD: 23 had acidic reflux, whereas 9 had combined reflux [acidic + weakly acidic reflux (WAR)]. The groups were similar in preoperative age, body mass index, and comorbidities. At 12 and 60 months, significant improvement in questionnaire scores was observed in group B patients. No manometric changes occurred in both groups; 24-hour MII-pH monitoring showed a significant reduction in acid exposure, but an increase of WAR in both group A (from 0% to 52% to 74%) and group B (from 35% to 42% to 77%). At long-term follow-up, esophagitis was found in 14 group A (30%) and in 18 group B patients (69%) (P < 0.001).
  
  
  CONCLUSIONS
  LRYGB allows to obtain an effective GERD symptom amelioration and a reduction in acid exposure. However, 3 out 4 patients present with distal esophagus exposure to WAR.
authors.affiliation: General Surgery and Center for Minimal Invasive Surgery, Department of Surgical Sciences - University of Turin, corso A.M. Dogliotti, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Rebecchi
authors.forename: Marco E
authors.initials: ME
authors.lastname: Allaix
authors.forename: Elettra
authors.initials: E
authors.lastname: Ugliono
authors.forename: Claudio
authors.initials: C
authors.lastname: Giaccone
authors.forename: Mauro
authors.initials: M
authors.lastname: Toppino
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D000328:Adult; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome