Gastric Bypass May Be Best for Obese Patients With GERD

Laurie Barclay, MD

July 01, 2002

July 2, 2002 -- For obese patients needing surgery for gastroesophageal reflux disease (GERD), laparoscopic Roux-en-Y gastric bypass is more effective than the standard Nissen fundoplication, according to a study reported in the July issue of Surgical Endoscopy. While controlling symptoms of GERD, the bypass procedure offers the added benefit of substantial weight loss.

"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," senior author Philip Schauer, MD, from the University of Pittsburgh School of Medicine in Pennsylvania, says in a news release.

The study enrolled 152 morbidly obese patients with daily symptoms of GERD requiring medical management. Initial mean body weight was 289 pounds, mean body mass index was 48 kg/m2, and most patients had other comorbidities of obesity including high blood pressure, sleep apnea, high cholesterol, depression, and type 2 diabetes.

One year after Roux-en-Y gastric bypass surgery, mean excess weight loss was 68.8%. There was a significant decrease in the proportion of patients experiencing GERD-related symptoms, including heartburn (from 87% to 22%; P<.001); water brash (18% to 7%; P<.05); wheezing (40% to 5%; P<.001); laryngitis (17% to 7%; P<.05); and aspiration (14% to 2%, P<.01).

Postoperative use of proton pump inhibitors decreased from 44% to 9% ( P<.001) and use of H2 blockers decreased from 60% to 10% ( P<.01). Overall patient satisfaction with the gastric bypass procedure was 97%.

"These results appear to be at least comparable to Nissen fundoplication," Schauer says. "Gastric bypass, as opposed to fundoplication or other anti-reflux procedures, may be a more appropriate surgical approach since it is effective in treating GERD as well as many other serious co-morbidities."

Surg Endosc. Published online May 3, 2002.

Reviewed by Gary D. Vogin, MD



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