Outcomes of Roux-en-Y Gastric Bypass Surgery on GORD in Obese Patients

Overview

This systematic review and meta-analysis evaluated the impact of primary Roux-en-Y gastric bypass (RYGB) surgery on gastro-oesophageal reflux disease (GORD) in obese patients. The analysis focused on changes in GORD symptoms, proton-pump inhibitor (PPI) use, and objective reflux measures such as the DeMeester score, alongside perioperative outcomes.

Background

Obesity, defined as a BMI over 30 kg/m2, is associated with multiple comorbidities including GORD, which can lead to Barrett’s oesophagus and oesophageal adenocarcinoma. Diagnosis of GORD requires objective evidence such as erosive oesophagitis or abnormal acid exposure on pH monitoring. Bariatric surgery, particularly RYGB, is an effective treatment for obesity and related conditions, but its effects on GORD symptoms and acid reflux remain unclear. This review aims to clarify the benefits and risks of RYGB on GORD to guide clinical decision-making.

Data Highlights

The review included studies published between 2000 and 2023 reporting GORD outcomes after RYGB. Data extracted encompassed symptom improvement, PPI discontinuation, DeMeester scores, length of hospital stay, and BMI changes. Quality assessment was performed using the Newcastle–Ottawa Scale, and evidence levels were graded according to Oxford criteria. Statistical analysis utilized weighted mean differences with 95% confidence intervals and heterogeneity assessment.

Key Findings

• RYGB surgery is associated with significant improvement in GORD symptoms in obese patients.
• A substantial proportion of patients were able to discontinue PPI therapy following RYGB.
• Postoperative DeMeester scores showed a statistically significant reduction, indicating decreased acid reflux.
• RYGB resulted in effective weight loss as demonstrated by a significant reduction in BMI postoperatively.
• Perioperative outcomes such as length of hospital stay and complication rates were acceptable, supporting the safety of RYGB.
• There is a lack of high-quality randomized controlled trials specifically addressing GORD outcomes post-RYGB, highlighting the need for further research.

Clinical Implications

Clinicians can consider RYGB as a dual therapeutic option for obese patients with coexisting GORD, given its potential to improve reflux symptoms and reduce dependence on acid-suppressive medications. Preoperative counseling should include discussion of the benefits on GORD as well as the surgical risks. Objective assessment of reflux pre- and postoperatively may aid in monitoring treatment response.

Conclusion

RYGB surgery offers significant benefits in reducing GORD symptoms and acid reflux in obese patients, alongside effective weight loss and manageable perioperative outcomes. These findings support its role in the integrated management of obesity complicated by GORD.

References

1. Systematic Review and Meta-Analysis, 2024 -- Outcomes of Roux-en-Y Gastric Bypass Surgery on Gastro-Oesophageal Reflux Disease in Obese Patients