Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common condition in obesity. The impact of Roux-en-Y gastric bypass (RYGBP) on GERD is poorly known. We studied the effect of the RYGBP on GERD in patients with morbid obesity (MO).

METHODS: Twenty consecutive patients with MO (BMI > 40 kg/m(2)) were studied before and 6 months after RYGBP. GERD symptoms were evaluated with Carlsson-Dent questionnaire (CDQ). All the patients underwent esophageal manometry and ambulatory 24-h pH-metry. Chi-square test was used to compare categorical variables, and Wilcoxon test was used for numerical variables. A p value under 0.05 was considered significant.

RESULTS: There were 16 women (80%) and 4 men (20%) with mean age 38.9 +/- 6.9 years included in this study. BMI was 48.5 +/- 6.2 kg/m(2) and 33.2 +/- 4.5 kg/m(2) before and after RYGBP, respectively. Mean weight reduction was 42.5 +/- 9.7 kg (p < 0.001). Reflux symptoms measured by CDQ and esophageal acid exposure improved significantly after RYGBP. The percentage of time of pH < 4 was 10.7 +/- 6.7 before and 1.6 +/- 1.2 after the surgical procedure (p < 0.001). LES basal pressure before and after the RYGBP was 18 +/- 11 and 20.1 +/- 5.6 mmHg (p = 0.372), and the esophageal body amplitude was 104.2 +/- 47.2 and 75.1 +/- 36.2 mmHg, respectively (p = 0.005).

CONCLUSION: RYGBP improves GERD symptoms and reduces esophageal acid exposure in patients with MO.