Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery

Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment.

Automated summary

Bariatric surgeries can lead to de-novo gastroesophageal reflux disease (GERD) or worsen pre-existing GERD. The increasing rates of obesity and bariatric surgeries worldwide have resulted in more patients needing post-surgical GERD evaluation. However, there is currently no standardized approach for assessing GERD in these patients. In this review, we discuss the relationship between GERD and the most common bariatric surgeries, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), focusing on the underlying pathophysiology, objective assessment methods, and anatomical and motility disturbances. We propose a stepwise algorithm for diagnosing GERD after SG and RYGB, identifying the underlying cause, and guiding management and treatment.