Gastric Bypass May Ease Symptoms of Reflux Disease in Morbidly Obese

By Frank Raczkiewicz

Morbidly obese people who undergo minimally invasive gastric bypass surgery to lose weight may also experience a reduction in their symptoms of gastroesophageal reflux disease (GERD), according to a study in the July issue of the journal Surgical Endoscopy.

The study found that more than 90 percent of patients achieved significant improvement or resolution of their GERD symptoms after bypass surgery.

GERD occurs when stomach acid spills into the esophagus because of a faulty valve at the bottom of the esophagus. The result is chronic heartburn.

“GERD and morbid obesity often coexist, not only because they are both very common but also because obesity is a major risk factor for GERD; 50 to 70 percent of patients seeking gastric bypass surgery have GERD. Many of the lifestyle changes aimed at treating GERD are intended to encourage weight loss,” said Philip Schauer, M.D., senior author of the study, assistant professor of surgery in the University of Pittsburgh School of Medicine, director of both bariatric and endoscopic surgery, and codirector of the Mark Ravitch/Leon C. Hirsch Center for Minimally Invasive Surgery.

GERD is usually treated with antacid medications or, in more serious cases, with drugs called proton pump inhibitors and histamine 2 blockers. When these fail, surgery to correct the faulty valve remains the only option.

The study enrolled 152 patients who met the criteria for GERD, had daily symptoms, and required medical management. Initial mean body weight was 289 pounds and most patients had other comorbidities of obesity, including high blood pressure, sleep apnea, high cholesterol, depression, type two diabetes, and others.

To assess changes in GERD symptoms after surgery, patients who participated in the study and who had at least six months of follow-up were interviewed and asked to complete three surveys related to their reflux disease and their quality of life following bypass surgery.

One year after Roux-En-Y gastric bypass surgery, a type of surgery that greatly reduces the size of the stomach, mean excess weight loss was 68 percent.

Patients had a significant decrease in GERD symptoms, including heartburn (from 87 percent to 22 percent), wheezing (from 40 percent to 5 percent), and laryngitis (17 percent to 7 percent), among others.

Medication use also decreased significantly both for proton pump inhibitors (from 44 percent to 9 percent) and for histamine 2 blockers (from 60 percent to 10 percent). Furthermore, chronic medication use for GERD decreased from 100 percent to 3 percent after the surgery.

“These results appear to be at least comparable to Nissen fundoplication, a surgical procedure used to treat GERD,” said Schauer. “Gastric bypass, as opposed to fundoplication or other antireflux procedures, may be a more appropriate surgical approach since it is effective in treating GERD as well as many other serious co-morbidities.”