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PREOPERATIVE RISK FACTORS FOR WORSENED GERD-HRQL FOLLOWING BARIATRIC SURGERY
Colin G. DeLong
*, Lily Stalter, Mads Owen, Kristen L. Patterson, Luke M. Funk, David A. Harris, Anne O. Lidor
Department of Surgery, University of Wisconsin, Madison, WI
Introduction: Following bariatric surgery, new or worsened gastroesophageal reflux disease (GERD) occurs in up to 25% of cases. Prediction of postoperative GERD is difficult and there is no consensus for objective preoperative evaluation of GERD risk factors in patients considering bariatric surgery. The objective of this study was to identify risk factors for postoperative GERD in patients undergoing bariatric surgery by evaluating standardized pre- and postoperative GERD assessments and to identify best practices for risk assessment.
Methods: A retrospective medical record review utilizing a prospectively maintained database of patients who underwent primary minimally invasive sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 07/2022—04/2024 at a single academic tertiary care referral center was performed. Adult patients who underwent preoperative esophagogastroduodenoscopy (EGD) and who completed pre- and post-operative GERD Health Related Quality of Life (GERD-HRQL) questionnaires were included. Patient demographics, preoperative endoscopic findings, and procedure type were evaluated using univariate logistic regression to identify risk factors for patients with a worsened GERD-HRQL score following surgery, within SG and RYGB subgroups.
Results: 139 patients were included with the following demographics: mean age 46.1 ± 10 years, 112 (80.1%) female, mean BMI 45.5 ± 7 kg/m
2. 43 (30.9%) patients underwent RYGB and 96 (69.1%) underwent SG. 74 (53.2%) patients had preoperative diagnosis of GERD, 33 (76.7%) of those patients undergoing RYGB and 41 (42.7%) of the patients undergoing SG. The mean preoperative GERD-HRQL score was 7.35 ± 8.1 for RYGB and 4.01 ± 4.9 for SG. The mean decrease in GERD score was 4.60 ± 10.3 after RYGB and 0.81 ± 6.9 after SG. The distribution of change in GERD-HRQL is shown in Figure 1. 10 (23.3%) RYGB patients and 29 (30.2%) SG patients had worsened GERD-HRQL score postoperatively. Baseline GERD-HRQL score ? 5 was associated with improved GERD-HRQL postoperatively on univariate logistic regression (Table 1), while age, gender, BMI, and endoscopic findings were not significantly associated with this outcome.
Conclusion: Most patients experience improved GERD-HRQL scores following bariatric surgery. The incidence of worsened GERD-HRQL is likely higher following SG versus RYGB. Preoperative risk factors including endoscopic findings were not statistically significantly associated with worsening of GERD-HRQL following bariatric surgery, while baseline GERD-HRQL score ? 5 was associated with improvement in scores after both SG and RYGB. Larger studies are needed to fully investigate the association of endoscopic findings with an increase in GERD-HRQL following bariatric surgery.
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