Evaluation of Patient Reported Gastroesophageal Reflux Severity at Baseline and at One-Year after Bariatric Surgery
Ehlers AP, Thumma JR, Finks JF, Carlin AM, Ghaferi AA, and Varban OA. Evaluation of Patient Reported Gastroesophageal Reflux Severity at Baseline and at One-Year after Bariatric Surgery. Ann Surg 2020.
Annals of surgery
OBJECTIVE: To assess patient-reported gastroesophageal reflux disease (GERD) severity before and after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
SUMMARY BACKGROUND DATA: Development of new-onset or worsening GERD symptoms following bariatric surgery varies by procedure, but there is a lack of patient-reported data to help guide decision-making.
METHODS: Retrospective cohort study of patients undergoing bariatric surgery in a statewide quality collaborative between 2013-2017. We used a validated GERD survey with symptom scores ranging from 0 (no symptoms) to 5 (severe daily symptoms) and included patients who completed surveys both at baseline and one-year after surgery (n = 10,451). We compared the rates of improved and worsened GERD symptoms after SG and RYGB.
RESULTS: Within our study cohort, 8,680 (83%) underwent SG and 1,771 (17%) underwent RYGB. Mean baseline score for all patients was 0.94. Patients undergoing SG experienced similar improvement in GERD symptoms when compared to RYGB (30.4% vs 30.8%, p = 0.7015). However, SG patients also reported higher rates of worsening symptoms (17.8% vs 7.5%, p < 0.0001) even though they were more likely to undergo concurrent hiatal hernia repair (35.1% vs 20.0%, p < 0.0001). More than half of patients (53.5%) did not report a change in their score.
CONCLUSIONS: Although SG patients reported higher rates of worsening GERD symptoms when compared to RYGB, the majority of patients (>80%) in this study experienced improvement or no change in GERD regardless of procedure. Using clinically relevant patient-reported outcomes can help guide decisions about procedure choice in bariatric surgery for patients with GERD.
ePub ahead of print