Weight-Loss Surgeries Not Created Equal for Heartburn Patients

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GERD symptoms not improved in laparoscopic sleeve gastrectomy compared to gastric bypass surgery

February 5, 2014 / Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

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(dailyRx News) Surgery to help with weight loss is becoming more common and more varied, but these surgeries might not help with every weight-related issue, a new study says.

The study focused on a procedure called laparoscopic sleeve gastrectomy and it's effect on a common weight-related issue — heartburn symptoms.

The researchers found that laparoscopic sleeve gastrectomy did not help improve heartburn troubles in most patients, but another surgery, gastric bypass, did seem to ease the symptoms in over half of patients.

"Try a food diary to track which foods trigger unpleasant symptoms."

In gastroesophageal reflux disease (GERD), stomach acid flows back into the esophagus, causing uncomfortable symptoms like heartburn.

According to the authors of this study, who were led by Matthew J. Martin, MD, of the Department of Surgery at Madigan Army Medical Center in Ft. Lewis, Washington, GERD is a common issue for the overweight and obese, and methods that solve the weight problem can often help ease GERD symptoms.

This study focused on comparing the effects of two weight loss surgeries, laparoscopic sleeve gastrectomy (LSG) and gastric bypass, on GERD symptoms.

In LSG, most of the stomach is removed, and in gastric bypass, the stomach is separated into two smaller pouches and the small intestine is rearranged. To explore GERD in patients across the US who had one of these procedures, Dr. Martin and team used data from the Bariatric Outcomes Longitudinal Database between January 1, 2007 and December 31, 2010.

The researchers identified 4,832 participants who underwent LSG and 33,867 who underwent gastric bypass. Of the LSG group, 44.5 percent had GERD prior to their surgery, and the same was true of 50.4 percent of the gastric bypass group.

Of the LSG patients with preexisting GERD, most (84.1 percent) continued to experience GERD after their surgery, and only 15.9 percent saw GERD symptoms end. In addition, 8.6 percent of the LSG patients who did not have GERD before surgery developed the condition afterwards.

In the gastric bypass group, however, 62.8 percent of those with GERD saw symptoms end within 6 months of the procedure.

The researchers also found an overall association with preexisting GERD and post-operative complications. For example, 15.1 percent of participants with GERD developed post-op complications, compared to 10.6 percent of their peers without GERD.

"Laparoscopic sleeve gastrectomy did not reliably relieve or improve GERD symptoms and induced GERD in some previously asymptomatic patients," Dr. Martin and team wrote.

"People who struggle with excessive weight often also struggle with reflux of stomach acid back into the esophagus. This is commonly referred to as heartburn," explained Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC.

"Not all weight loss procedures are created equally, however, and many of the stomach sparing procedures appear to address this condition better," said Dr. Hall, who was not involved in this study. "The important take home message is to make sure you discuss all symptoms with your physician as it may affect which procedure is selected to treat your condition."

Further research to explore the relationship between LSG and GERD is needed. However, the researchers suggested that preexisting GERD be considered as patients choose a weight-loss surgery.

"On the basis of these results and a review of the currently available literature, we believe that all patients should be evaluated for the presence and severity of GERD and counseled regarding the relative efficacy of LSG vs [gastric bypass] or other bariatric operations before surgery," they wrote.

The study was published online February 5 by JAMA Surgery. No conflicts of interest were reported.

Review Date: 
February 4, 2014
Last Updated:
February 6, 2014