Longitudinal Relationships Among GERD Symptoms, Endoscopy, and Histopathology Post-OAGB

Overview

This study longitudinally evaluated the interplay between GERD symptoms, endoscopic findings, and histopathological changes in patients following One-Anastomosis Gastric Bypass (OAGB). It revealed that symptom presence does not consistently correlate with macroscopic or microscopic reflux-related abnormalities, highlighting the complexity of post-OAGB reflux assessment.

Background

Obesity is a major global health issue effectively managed by metabolic and bariatric surgery (MBS), with One-Anastomosis Gastric Bypass (OAGB) gaining popularity due to its safety and efficacy. Post-OAGB gastroesophageal reflux disease (GERD) remains controversial, as symptoms alone may not reliably indicate reflux-related mucosal damage. Prior studies have shown discordance between reflux symptoms and endoscopic or histopathological findings, but no research has comprehensively assessed these parameters longitudinally. This study aims to fill this gap by systematically analyzing the evolution and relationships of GERD symptoms, endoscopic, and histopathological changes over time after OAGB.

Data Highlights

Key Findings

• GERD symptoms assessed by GerdQ did not consistently correlate with endoscopic or histopathological evidence of reflux at years 1 and 3 post-OAGB.
• Macroscopic inflammatory changes were observed in the gastrojejunostomy, gastric pouch, and distal esophagus even in asymptomatic patients.
• Histopathological abnormalities were detected in biopsies despite absence of clinical symptoms, indicating subclinical mucosal injury.
• Discordance between symptomatology and objective findings suggests that relying solely on symptoms may underestimate reflux-related mucosal damage post-OAGB.
• Routine upper endoscopy with systematic biopsies is recommended for comprehensive reflux evaluation after OAGB.
• Longitudinal assessment revealed evolving patterns of reflux-related changes, underscoring the importance of follow-up at multiple time points.

Clinical Implications

Clinicians should be aware that GERD symptoms post-OAGB may not reliably reflect underlying mucosal injury or inflammation. Incorporating routine upper endoscopy and targeted biopsies into postoperative surveillance protocols can facilitate early detection of reflux-related complications. This approach enables timely management and may improve long-term outcomes in OAGB patients.

Conclusion

The study underscores the complex and often discordant relationships among GERD symptoms, endoscopic findings, and histopathological changes following OAGB. Comprehensive longitudinal evaluation is essential for accurate diagnosis and management of post-OAGB reflux.

References

1. ASMBS and IFSO Guidelines and Registries (2020-2022) -- OAGB Endorsement and Outcomes
2. GerdQ Validation Studies (2011-2019) -- GERD Symptom Assessment in Bariatric Patients
3. Los Angeles Classification (1994) -- Endoscopic Grading of Esophagitis
4. ASMBS Guidelines (2019) -- Post-Bariatric Surgery Endoscopy and Biopsy Protocols