GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study

Introduction: Gastroesophageal reflux disease (GORD) after bariatric surgery (BS) is a debated topic. This study investigated the prevalence of GORD and related oesophageal complications after bariatric procedures – namely, adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en- Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). Methods: This was a prospective multicentre study designed to evaluate long-term effects of BS on GORD. Patients were studied at baseline, at >10 years after AGB, SG, RYGB and at >3 years after OAGB (due to its more recent recognition as a standard bariatric procedure). Patients were assessed by endoscopy and GORD symptom evaluation. Results: A total of 241 patients were enrolled. A minimum follow-up of 10 years was reached by 193 patients after AGB (n=57), SG (n=95), RYGB (n=41) and by 48 subjects >3 years after OAGB. GERD symptoms increased after AGB and SG (from 14.0% to 31.6% and 26.3% to 58.9%; P<0.0001, respectively), improved after RYGB (from 36.6% to 14.6%; P<0.0001) and were unchanged after OAGB. The overall prevalence of erosive oesophagitis was greater after SG (74.7%) than AGB (42.1%), RYGB (22.0%), or OAGB (22.9%), (P<0.0001). Barrett’s oesophagus was found only after SG in 16.8%. More biliary-like gastric stagnation was found in SG and OAGB patients (79.7% and 69.4%, respectively) than other groups (P<0.0001). Biliary-type reflux into the oesophagus was worst after SG (74.7%). Conclusions: Bariatric surgery leads to gastroesophageal consequences of variable extent. Sleeve gastrectomy is particularly troublesome with a large proportion developing Barrett’s oesophagus.