Mild to moderate GERD before sleeve: Can we better predict post-operative GERD?

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Abstract

Gastroesophageal reflux disease (GERD) can be debilitating for patients after sleeve gastrectomy (SG). However, no clear numerical thresholds have been identified to help predict which patients will develop worsening symptoms post-operatively. We therefore sought to characterize which pre-operative wireless pH testing and endoscopy findings were associated with GERD after SG.Patients with a history of SG and pre-operative wireless pH studies were identified. Abnormal DeMeester score was defined as?>?14.7 and abnormal acid exposure time (AET) as?>?4% of time with a pH??0.9). In univariate analysis, abnormal DeMeester score (OR 1.25, p?=?0.779), grade A or B esophagitis (OR?=?1.70, p?=?0.554), or abnormal AET (OR?=?1.25, p?=?0.779) were not predictive of post-operative GERD. However, a threshold of DeMeester score of?=?30 or AET?=?10.35 was predictive of post-operative GERD.In patients with moderate GERD, standard cutoffs of abnormal DeMeester score or AET were not predictive of post-operative GERD, however a threshold DeMeester score of?=?30 or AET?=?10.35 was predictive. Patients with such findings should be particularly counseled about the risk of post-operative GERD and/or offered a Roux-en-Y gastric bypass.

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