GERD After Sleeve Gastrectomy Related to Proximal Gastric Pressurization

Sleeve gastrectomy (SG) has become a popular choice for weight loss due to its ease and effectiveness. However, it can worsen symptoms of esophageal reflux and lead to the development of gastroesophageal reflux disease (GERD). This study evaluated the effects of bariatric surgery on patients who underwent SG or Roux-en-Y gastric bypass (RYGB) versus nonsurgical patients and asymptomatic controls. It specifically focused on the patterns and consequences of pressurization of the proximal stomach, using high-resolution manometry (HRM) in these patients.

The study included patients who underwent HRM and ambulatory pH-impedance monitoring after SG (n=36) or RYGB (n=23) and symptomatic (n=113) and asymptomatic (n=15) control patients. The investigators found that both SG and RYGB patients experienced pressurization of the stomach during swallows and a straight leg raise maneuver. However, compared with RYGB, SG resulted in higher acid exposure time (AET; median, 6.0% vs 0.2%) and more reflux episodes (63.0 vs 37.5). Patients who underwent SG also had higher baseline intragastric pressure and lower trans-esophagogastric junction (EGJ) pressure gradients during pathological reflux. Multivariable analysis showed that SG and a low EGJ contractile integral were independently associated with increased AET and reflux episode numbers.