Gastroesophageal Reflux After Sleeve Gastrectomy: a Prospective Mechanistic Study

Evolution of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) is controversial. Some authors report worsening or improvement of preoperative GERD, others the occurrence of de novo GERD between 5 and 69%. The aims of this study are to evaluate the evolution of GERD after SG by ambulatory 24-h pH monitoring (APM) and to determine pre- and postoperative clinical and manometric factors associated with its evolution. Between 2013 and 2015, 47 patients operated in our center performed APM before and 1 year (14.8 +/- 4.9 months) after SG. GERD was defined as a percentage of time with esophageal pH < 4 (TpH < 4) > 4.2. Among them, 30 had pre- and postoperative high-resolution esophageal manometry (HRM). Thirty-one patients (66%) had no preoperative GERD (group 1), and 16 had preoperative GERD (group 2). One year after SG, mean TpH < 4 increased significantly in group 1 (5.8 +/- 4.6 vs. 1.8 +/- 1.1%, p < 0.01) whereas it was not modified in group 2 (7.4 +/- 6.6 vs. 6.6 +/- 2.6%). In group 1, 16 patients (52%) had de novo GERD whereas in group 2, 7 had no more GERD, 3 improved, and 6 worsened. Maximal intragastric pressure after swallows increased significantly at postoperative HRM only in patients with de novo GERD (49.2 +/- 22.0 vs. 25.4 +/- 9.4 mmHg, p = 0.03). No preoperative clinical or manometric parameters were predictive of postoperative GERD. One year after SG, esophageal acid exposure globally worsened, mostly because of de novo GERD, whereas 63% patients with preoperative GERD improved, without preoperative predictive clinical or manometric factor.