Nearly half of patients with coexisting gastroesophageal reflux disease (GERD) and severe obesity who underwent gastric bypass surgery still required continuous antireflux medication, suggesting an overestimation of gastric bypass efficacy for reflux symptoms, according to results from a study published in Alimentary Pharmacology & Therapeutics.
Investigators of the large population-based cohort study aimed to determine the long-term risk for persistent and recurring reflux symptoms after gastric bypass, defined as use of proton pump inhibitors or histamine-2 receptor antagonists for >6 months after surgery.
A total of 2454 participants (mean age, 46.1 years; 81.7% women) were followed for a median of 4.6 years; 48.8% of individuals experienced reflux recurrence within 2 years of gastric bypass and remained stable for up to 10 postoperative years.
High preoperative dosage of antireflux medication, older age, female sex, and comorbidity were risk factors associated with postsurgery reflux symptoms (incidence rate ratios, 1.77, 1.12, 1.28, and 1.26, respectively).
“In contrast to previous reports, the results of the present study indicate that the treatment effect of gastric bypass on reflux symptoms lasts for many years, but does not improve over time after surgery,” the authors noted.
“Physicians and patients should be aware of the limited effect of gastric bypass on reflux in patients with severe obesity, particularly in those with risk factors for postoperative reflux, that is, high dose of preoperative anti-reflux medication, older age, female sex and comorbidity,” they concluded.
Holmberg A, Santoni A, Xie S, Lagergren J. Gastric bypass in the treatment of gastro-oesophageal reflux symptoms.Aliment Pharmacol Ther. 2019;50(2):159-166.