Results of sleeve gastrectomy conversion to Roux-en-Y gastric bypass on gastroesophageal reflux disease symptoms and proton pump inhibitors use evolution over time

Jun 9, 2024Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

Changes in acid reflux symptoms and heartburn medicine use after converting sleeve gastrectomy to Roux-en-Y gastric bypass over time

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Abstract

70% of patients experienced complete resolution of gastroesophageal reflux disease (GERD) symptoms after conversion to Roux-en-Y gastric bypass (RYGB) from sleeve gastrectomy (SG).

Conversion to RYGB significantly decreased the rate of patients experiencing daily GERD symptoms from 10%.
A reduction in proton pump inhibitor (PPI) use was observed, with 16.6% of patients still requiring PPIs post-surgery.
60% of patients completely discontinued the use of PPIs after the conversion.
The procedure was associated with improved quality of life and symptom relief for patients suffering from GERD following SG.

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BACKGROUND: Although sleeve gastrectomy (SG) is associated with excellent results in the short term, it has been shown that it is plagued by weight regain and new onset or worsening of gastroesophageal reflux disease (GERD). These 2 clinical conditions are currently the 2 most frequent indications for revisional surgery. To date, only a few studies have focused exclusively on GERD. In a selected series of patients complaining of GERD symptoms after SG as a main complaint, we analyzed the efficacy of conversion to Roux-en-Y gastric bypass (RYGB), with a standardized surgical technique.

METHODS: This is a retrospective study including all consecutive cases of SG to RYGB conversion for GERD not controlled by medical treatment. We excluded all patients undergoing conversion for weight regain without GERD. Quality of life and GERD symptoms were evaluated at outpatient's clinic visits before and after surgery with 2 standardized questionnaires (Gastroesophageal Reflux Disease Questionnaire and Simplified Form 6).

RESULTS: This study showed that 70% of patients had complete resolution of GERD symptoms and 60% had completely discontinued proton pump inhibitors (PPIs). The conversion to RYGB resulted in a significant decrease in the rate of patients presenting daily symptoms of GERD and use of PPIs (10% and 16.6%, respectively; P < .019) and a dramatic increase in those without symptoms and no need for PPIs (70% and 60%, respectively; P < .001).

CONCLUSION: Conversion to RYGB is a good option for GERD complications after SG providing a high rate of symptom remission and PPI discontinuation. Conversion to RYGB in the setting of GERD complications after SG improves postoperative outcomes decreasing GERD symptoms and improving quality of life.

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Results of sleeve gastrectomy conversion to Roux-en-Y gastric bypass on gastroesophageal reflux disease symptoms and proton pump inhibitors use evolution over time

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