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GERD is the abreviation for Gastro esophageal Reflux Disease.

Symptoms of GERD include:

  1. Heartburn
  2. Water brash (reflex salivary hypersecretion in response to peptic esophagitis),
  3. Laryngitis
  4. Aspiration (passage of gastric fluid up the esophagus and down into the lungs)
  5. Wheezing
  6. Night time awakening with choking

As many as 55% of morbidly obese patients coming to surgery have symptoms of GERD.

GERD is more of a problem for obese people than those with normal weight because:

  1. Obese people are more sensitive to the presence of acid in the esophagus.
  2. Hiatal hernia, capable of promoting GERD by several mechanisms, is more common among the obese.
  3. Obese people have increased intra-abdominal pressure that displaces the lower esophageal sphincter and increases the gastro-esophageal gradient (pressure difference).
  4. Vagal nerve function abnormalities associated with obesity may cause a higher output of bile and pancreatic enzymes, which makes the refluxed gastric juices more toxic to the esophageal mucosa.

Adapted from Barak N Obes Rev 2002 Feb;3(1):9-15

The following abstracts from the medical literature about Gastroesophageal Reflux Disease were obtained through the National Library of Medicine.

Surg Endosc 2002 Jul;16(7):1027-31

Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass.

Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P.

Department of Surgery, Presbyterian University Hospital, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.

BACKGROUND: The purpose of this study was to determine the effect of laparoscopic Roux-en-Y gastric bypass (LRYGBP) on symptomatic control of gastroesophageal reflux disease (GERD). METHODS: Morbidly obese patients (n = 435) who underwent LRYGBP for morbid obesity were assessed for changes in GERD symptoms, quality of life, and patient satisfaction after surgery. RESULTS: A total of 238 patients (55%) had evidence of chronic GERD, and 152 patients (64%) voluntarily participated in the study. The mean body mass index (BMI) was 48 kg/m2. The mean excess weight loss was 68.8% at 12 months. There was a significant decrease in GERD-related symptoms, including heartburn (from 87% to 22%, p<0.001); water brash (from 18% to 7%, p<0.05); wheezing (from 40% to 5%, p<0.001) laryngitis (from 17% to 7%, p<0.05); and aspiration (from 14% to 2%, p<0.01) following LRYGBP. Postoperatively, the use of medication decreased significantly both for proton pump inhibitors (from 44% to 9%, p<0.001) and for the H2 blockers (from 60% to 10%, p<0.01). SF-36 physical function scores and the mental component summary scores improved after the operation (87 vs 71; p<0.05 and 83 vs 66; p<0.05, respectively). Overall patient satisfaction was 97%. CONCLUSION: LRYGBP results in very good control of GERD in morbidly obese patients with follow-up as late as 3 years. Morbidly obese patients who require surgery for GERD may be better served by LRYGBP than fundoplication because of the additional benefit of significant weight loss.

Obes Surg 1998 Feb;8(1):35-8

Roux-en-Y gastric bypass: an effective antireflux procedure in the less than morbidly obese.

Jones KB Jr.

LSU Medical Center, Shreveport, Louisiana, USA.

BACKGROUND: Since Roux-en-Y gastric bypass (RYGBP) is an excellent antireflux procedure, why is it necessary to do it only for those who are morbidly obese: why not anyone who has had a longstanding severe weight problem with chronic disabling reflux esophagitis? METHODS: RYGBP was done primarily as an antireflux procedure in 332 patients late from 1987 through October 1996. Eighty-nine were less than 100 lb (45 kg) overweight. Forty-five were lost to follow-up. All but one had Visick ratings from 2 to 4 preoperatively. Thirty-one were primary RYGBP and 13 were conversions from previous gastroplasties. The diagnosis in each case was made by esophagogastroscopy with esophageal biopsy with or without the Bernstein test when indicated. RESULTS: Postoperatively, only one patient was symptomatic. The remaining had Visick ratings of 1. The average preoperative weight of 192 lb (87 kg) dropped to 145 lb (66 kg) postoperatively, or 67% of excess weight loss at a mean of 56 months. Compared to the morbidly obese group, there was no significant difference in 1-year postoperative laboratory values. CONCLUSION: This study supports the efficacy and safety of RYGBP for reflux esophagitis in the less than morbidly obese patient. Esophagitis is truly a comorbid condition of severe obesity, and it should be accepted as such. The arbitrary elimination from the consideration of candidacy for this procedure by those with a body mass index of less than 35 kg/m2 and unproven comorbidity appears unjustified.

Obes Surg 1997 Dec;7(6):479-84

Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass.

Smith SC, Edwards CB, Goodman GN.

Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA.

BACKGROUND: Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated. Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for this disease. METHODS: One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity of their disease. Their preoperative symptoms were compared to those experienced postoperatively. RESULTS: One hundred thirty patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy, 8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively. CONCLUSIONS: Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications is appropriate in selected cases.



 

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