Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass

Borbély, Yves Michael; Kröll, Dino; Nett, Philipp C.; Moreno, Peter; Tutuian, Radu; Lenglinger, Johannes

doi:10.1016/j.soard.2018.02.028

Cited by 50 publications

(26 citation statements)

References 34 publications

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“…Moreover, modern diagnosis of true GERD was recently redefined offering a broad spectrum of tools from symptom assessment, endoscopy, and ambulatory pH monitoring to esophageal function testing (EFT) ( [10]. EFT may reveal esophageal dysmotility, rather frequently observed after bariatric surgery, that potentially mimics or interferes with GERD [11,12]. Concordantly, EFT has also been revolutionized with the development of high-resolution manometry (HRM), a fundamental technological advance in modern medicine.…”

Section: Introductionmentioning

confidence: 99%

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

et al. 2019

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Background The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. Methods Consecutive morbidly obese (BMI ≥ 35 kg/m 2 ) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively.Results Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m 2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. Conclusions The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery.

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Section: Introductionmentioning

confidence: 99%

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

et al. 2019

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“…Hiatal hernia occurrence after RYGB can occur quite frequently after gastric bypass [ 12 ]. The relatively small size of the gastric pouch, dissection injury to sling fibers, and tissue strength changes related to rapid weight loss may all predispose patients to post-operative hiatal hernia occurrence after gastric bypass.…”

Section: Discussionmentioning

confidence: 99%

Type IV Hiatal Hernia Containing the Gastric Pouch and Proximal Roux Limb: A Rare Cause of Bowel Obstruction Following Roux-en-Y Bypass Surgery

Nance

Shapera

Wheeler

2020

Cureus

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Roux-en-Y gastric bypass (RYGB) is considered the gold standard for weight loss surgery and is an effective, safe treatment for morbid obesity and associated metabolic derangements. Complications such as small bowel obstruction are rare with a reported incidence of 5%. Obstruction caused by hiatal herniation of the gastric pouch and alimentary limb occurs even less frequently. Prompt recognition and treatment are imperative as delayed intervention may result in significant morbidity. At the time of this manuscript there have only been four reported cases in the literature highlighting a paucity of clinical guidance for the recognition and management of this complication. Here we present a case of acute small bowel obstruction secondary to hiatal herniation of the gastric pouch and proximal Roux limb. Furthermore, we review the literature and discuss the key aspects for the management of this complication.

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“…The malabsorptive component of this RYGB is minor (similar to Short-Limb Gastric Bypass), since only 40-70 cm BPL is excluded completely from the food stream, whereas in the 150 cm of AL only the uptake of lipides and triglycerides is excluded [13]. RYGB is usually indicated for patients suffering from gastro-esophageal reflux disease [14].…”

Section: One-anastomosis Gastric Bypassmentioning

confidence: 99%

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

Felsenreich

Langer

Eichelter

et al. 2021

JCM

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The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.

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Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after Roux-en-Y gastric bypass

Cited by 50 publications

References 34 publications

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

Modern Esophageal Function Testing and Gastroesophageal Reflux Disease in Morbidly Obese Patients

Type IV Hiatal Hernia Containing the Gastric Pouch and Proximal Roux Limb: A Rare Cause of Bowel Obstruction Following Roux-en-Y Bypass Surgery

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

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