Gastroesophageal reflux disease following sleeve gastrectomy: an overview and practical guide

Gastroesophageal Reflux Disease (GERD) is a frequent complication following Sleeve Gastrectomy (SG). This study reviews the incidence, pathophysiology, and management of GERD after SG.

A comprehensive electronic literature review spanning 2004 to 2023 was conducted, encompassing PubMed, Scopus, and the Cochrane Library databases.

The prevalence of GERD is high in obese patients (40–70%) due to increased intra-abdominal pressure. Routine upper gastrointestinal endoscopy is recommended because of the high incidence of findings, even in asymptomatic patients. Studies indicate that concomitant hiatal hernia repair during SG can reduce GERD symptoms. However, conflicting results persist regarding the efficacy of various surgical techniques. Following SG, GERD improvement is often reported in the short term. However mid- and long-term results tend to show an increase in the prevalence of GERD. There is insufficient evidence to confirm a direct relationship between SG and esophageal adenocarcinoma. In the case of de novo GERD after SG, initial treatment includes lifestyle modifications and acid-reducing medications. Conversion to Roux-en‑Y gastric bypass (RYGB) is effective for managing refractory GERD and Barrett’s esophagus, with remission rates of up to 80%.

The study highlights the importance of preoperative assessment, tailored surgical approaches, and long-term postoperative monitoring to effectively manage and mitigate GERD in SG patients.