Gastroesophageal reflux disease and the phantom of Barrett's esophagus after most-often-used bariatric procedures: are future investigations necessary?

Abstract

Background: Studies have investigated the incidence of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) after common bariatric surgeries. However, many of these studies have bias or limitations. Therefore, it is crucial to determine the true incidence of GERD in long-term follow-ups (FUs) post-surgery.

Aims: The aim of this study was to review and summarize long-term data regarding the incidence of post-surgical GERD and BE after various bariatric procedures, discuss the characteristics of current information available, and establish the need for future studies to determine objective functional outcomes that have not yet been reported.

Methods: A narrative review was conducted using multiple electronic databases, including the review of 15 meta-analyses and over 200 articles.

Results: The quality of studies analyzing GERD and BE following bariatric surgery varies widely. Some papers provide detailed outcomes, while others offer limited information. The reported rate of de novo postoperative GERD development after sleeve gastrectomy varies from 4.06 to 74.7% (mean=33.8±19.1), and the incidence of BE ranges from 0.2 to 27% (mean=8.2±7.5). After Roux-en-Y gastric bypass (RYGB), similar variability is observed, with BE incidence ranging from 1.6 to 17.5% (mean=7.5±5.9). In the case of one-anastomosis gastric bypass (OAGB), scarce information is available and most reports are incomplete. The incidence of erosive esophagitis ranges from 15 to 70%, with BE incidence reported in only two papers (1-9.5%). For procedures such as single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), fundoplication-sleeve, or sleeve bipartition, few specific data are available, with most reports limited to symptoms and lacking findings such as esophagitis, hiatal hernia, or BE.

Conclusion: This revision provides evidence that SG may indeed lead to an increased risk of BE. Numerous studies suggest that RYGB protects against BE. Other bariatric procedures must be extensively evaluated. Relatively low quality of available literature on this topic was observed; therefore, well-controlled prospective studies with long-term FUs are necessary to fully understand the effect of bariatric surgery on BE.