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  • Review Article
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Consequences of bariatric surgery on oesophageal function in health and disease

Nature Reviews Gastroenterology & Hepatology volume 13, pages 111–119 (2016)Cite this article

Subjects

Key Points

  • Obesity confers an increased risk of oesophageal disorders, most notably GERD

  • Bariatric surgery results in weight-loss, but is associated with specific risks in the development of oesophageal disorders, which can be partly predicted based on preoperative symptoms

  • Roux-en-Y gastric bypass attains the safest risk profile and is the most efficient option in the amelioration of GERD and prevention of other oesophageal motility disorders

  • Laparoscopic adjustable gastric band is the best-studied procedure with evidence for postoperative development of GERD and de novo oesophageal dysmotility

  • Limited data on the complications of sleeve gastrectomy exist to date, but it has been shown to lead to GERD postoperatively in previously asymptomatic patients

  • Further high-quality studies are needed to better understand the interplay between oesophageal disorders and bariatric operations, as the relationship is complicated and beyond weight loss alone

Abstract

Obesity is a continuing epidemic with substantial associated morbidity and mortality. Owing to the limitations of lifestyle modifications and pharmacological options, bariatric surgery has come to the forefront as an efficient method of achieving sustained weight loss and decreasing overall mortality in comparison with nonsurgical interventions. The most frequently performed bariatric operations are either purely restrictive, such as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or restrictive–malabsorptive, such as the Roux-en-Y gastric bypass (RYGB). Each operation results in weight loss, but can also have unintended effects on the health of the oesophagus. Specifically, operations might lead to oesophageal dilation or the development of GERD. LAGB is the best-studied procedure with notable evidence for postoperative worsening of GERD and pseudo-achalasia, which increases lower oesophageal pressure and causes aperistalsis. In some studies, LSG initiates not only a worsening of GERD, but also the formation of de novo GERD in patients without preoperative GERD symptoms. RYGB demonstrates the most profound evidence for improvement of GERD symptoms and preservation of oesophageal motility. Future high-quality studies will be required to better understand the interaction between bariatric surgery and oesophageal disease.

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Figure 1: Mechanism of action for GERD in obesity.
Figure 2: Types of bariatric surgery.
Figure 3: Major dilated oesophagus 7 years after LAGB (stage IV).
Figure 4: Oesophageal disorders as a consequence of bariatric surgery.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Centre for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, 1660 TVC, Nashville, 37232–5280, Tennessee, USA

    Rishi D. Naik, Yash A. Choksi & Michael F. Vaezi

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  1. Rishi D. Naik
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  2. Yash A. Choksi
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  3. Michael F. Vaezi
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Contributions

All authors researched data for the article, provided a substantial contribution to discussion of content and wrote the article. M.F.V. and R.D.N. reviewed and edited the manuscript before submission.

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Correspondence to Michael F. Vaezi.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Laparoscopic adjustable gastric banding and relationship with oesophageal disease (DOCX 26 kb)

Supplementary Table 2

Laparoscopic sleeve gastrectomy and relationship with oesophageal disease (DOCX 27 kb)

Supplementary Table 3

Roux-en Y gastric bypass and relationship with oesophageal disease (DOC 58 kb)

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Naik, R., Choksi, Y. & Vaezi, M. Consequences of bariatric surgery on oesophageal function in health and disease. Nat Rev Gastroenterol Hepatol 13, 111–119 (2016). https://doi.org/10.1038/nrgastro.2015.202

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