Half of severely obese GERD patients still have reflux after surgery

By Reuters Staff

NEW YORK (Reuters Health) - 14/6/2019

Gastric-bypass surgery leads to rapid improvement in reflux symptoms in obese patients with gastroesophageal reflux (GERD), but about half still need anti-reflux medication afterwards, new research shows.

"This large and population‐based cohort study with long and complete follow‐up indicates that gastric bypass is an effective and long‐lasting treatment of GERD in only approximately 50% of patients with severe obesity," Dr. Dag Holmberg of the Karolinska Institutet in Stockholm and colleagues write in Alimentary Pharmacology and Therapeutics, online June 4.

"This is a lower success rate than in previous studies, indicating that the treatment effect may have been overstated," they add.

Gastric bypass is considered to be an effective treatment for GERD in severely obese individuals, and frequently recommended for GERD patients with a BMI of 35 or higher, Dr. Holmberg and his team note.

To better characterize the efficacy of gastric bypass as a GERD treatment for severely obese patients, they looked at 2,454 adults with reflux who underwent gastric bypass in Sweden in 2006-2015. Most study participants were female (81.7%), and median follow-up was 4.6 years.

During the year before gastric bypass surgery, study participants took an average of 442 daily doses of anti-reflux medication. Medication use declined by 39% in the year after surgery, to 272 daily doses.

Daily doses averaged 237 in the second year after surgery, 227 in the third year, and remained stable for up to 10 years after the operation.

In the year after surgery, 55.8% of patients had persistent or recurrent symptoms, and 48.8% continued to have symptoms in the second year.

Risk factors for continued reflux symptoms after gastric bypass included being over 50 versus younger than 40 (incidence rate ratio, 1.12) and being female (adjusted IRR, 1.28). Higher comorbidity scores were also significantly associated with continued reflux (IRR, 1.26 for Charlson Comorbidity Index of 2 or higher compared to 0).

Taking a high cumulative dose of anti-reflux medication in the year before surgery was the most important risk factor for having continued reflux symptoms (IRR 1.77).

"Physicians and patients should be aware of the limited effect of gastric bypass on reflux in patients with severe obesity, particularly in those with risk factors for postoperative reflux, that is, high dose of preoperative anti‐reflux medication, older age, female sex and comorbidity," the authors conclude.

SOURCE: https://bit.ly/2RjUHf5

Aliment Pharmacol Ther 2019.

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