Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux

Background: Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published. Methods: A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 ± 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper Gl endoscopy. Results: Total number of reflux episodes decreased from a mean value of 44.6 ± 23.7 SD preoperatively to 22.9 ± 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% ± 6.2% to 3.5% ± 3.7%, P=0.0009, and DeMeester score decreased from 38.5 ± 24.9 to 18.6 ± 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper Gl endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 ± 5.46 to 38.4 ± 6.45 (P<0.0001), excess weight from 60.0 kg ± 18.58 kg, 44.9% ± 6.56% to 38.4 kg ± 20.27 kg, 28.4% ± 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. Conclusions: The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.