Effect of Gastric Bypass on GERD in Obese Patients

Abstract

Gastroesophageal reflux disease (GERD) is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus. The prevalence of gastroesophageal reflux disease GERD has been increasing in the Western world. The prevalence of obesity has reached epidemic proportions. A high body mass index (BMI) increases the risk of GERD and there is a positive relationship between increasing BMI and prevalence of GERD and its complications. Esophageal peristalsis is an important component of the anti-reflux mechanism because it is the main determinant of esophageal clearance of the refluxate. Defective peristalsis is associated with severe GERD, both in terms of symptoms and of mucosal damage. Typical GERD symptoms include chest discomfort (heartburn) and regurgitation, while extra-esophageal symptoms, including wheezing, chronic cough, shortness of breath, hoarseness and unexplained chest pain. Failure to respond to appropriate anti-secretory medical therapy should prompt evaluation with upper GI Endoscopy evaluation, esophageal manometry and barium study. Several treatment options for GERD are available in obese patients, including lifestyle changes, dietary advice, physical activity and behavior changing strategies. The first step usually consists of lifestyle and dietary recommendations, often combined with acid inhibiting therapy, such as proton pump inhibitors (PPIs) and H2 blockers.