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

Background: The purpose of this study was to determine the effect of laparoscopic Roux-en-Y gastric bypass (LRYGBP) on symptomatic control of gas-troesophageal reflux disease (GERD). Methods: Morbidly obese patients (n = 435) who un-derwent 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. Post-operatively, 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.