Symptoms of Gastroesophageal Reflux Following Laparoscopic Sleeve Gastrectomy Are Related to the Final Shape of the Sleeve as Depicted by Radiology

Λαζούρα, Όλγα; Zacharoulis, Dimitris; Triantafyllidis, Georgios; Fanariotis, Michael; Sioka, Eleni; Papamargaritis, Dimitris; Tzovaras, George

doi:10.1007/s11695-010-0339-0

Cited by 98 publications

(48 citation statements)

References 34 publications

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“…Mechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric emptying (29), reduced plasma ghrelin levels (31), gastric sleeve anatomy (32), and hiatal hernia (33). In the cohort study by Himpens et al (34), GERD occurred at a rate of 23.6% at six years after surgery.…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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Gastroesophageal reflux disease (GERD) is known to present with various extraesophageal symptoms and complications. In contrast, several diseases affecting the motility of the esophagus and some approaches that alter the upper gastrointestinal tract anatomy may result in GERD. Certain diseases and conditions often mentioned with GERD will be briefly discussed in this section. Systemic SclerosisEsophageal motility is impaired in 70-90% of patients with systemic sclerosis (1-3). On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5-7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8). As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9-15). Diabetes MellitusFurthermore, various factors showing tendency to GERD were identified in diabetes mellitus. Among these,• Reduced salivary secretion associated with diabetic neuropathy, • Delayed gastric emptying, • Decreased acid clearance due to reduced motor activity of the esophagus/stomach related motor/autonomic neuropathy, • Increased sensory thresholds associated with sensory nerve damage of the esophagus, • Acid regurgitation caused by the increased frequency of transient LES relaxations related to neuropathy, CholecystectomyThe reservoir function of the gallbladder disappears after cholecystectomy, and bile flow becomes continuous (20,21). Qualitative changes may appear at the levels of gastrointestinal hormones (22,23). Consequently, alterations in the qualitative bile content and more frequent transient LES relaxation may occur (24). Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data. Uyanıkoğlu et al. (26) used the impedance method and reported increased reflux after surgery and that the pH was <4% higher than that before surgery; however, it was similar to the control group. In another study, Lin et al. (27) compared patients with hernia surgery and cholecystectomy. Reduction in the reflux symptom score was 35% in patients, while it was 39% in controls (p=0.11). Sleeve GastrectomyMechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric em...

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Section: Sleeve Gastrectomymentioning

confidence: 99%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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“…Most studies reported an increase in reflux symptoms during the first postoperative year followed by a gradual decrease in symptoms up to the third postoperative year [15].…”

Section: Gerd After Sleeve Gastrectomymentioning

confidence: 99%

Gastroesophageal Reflux Disease and Sleeve Gastrectomy

et al. 2015

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Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.

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“…The most relevant early surgical complications are leaks, bleeding and stenosis [23], while the most controversial long-term issues are related with gastroesophageal reflux disease (GERD) [24] and dilation of the gastric tubule. The major aim of this operation is the reduction in the gastric capacity, the final shape resulting in one of these three patterns according to Werquin's classification: real tubular, partial fundus persistence variant and partial antrum persistence variant [25,26]. The first one is the most desirable in order to obtain the best results in weight loss.…”

Section: Discussionmentioning

confidence: 99%