RNY relieves GERD

On January 11, 2010, in Uncategorized, by Andrea

Filing under the “duh” category for the medical community…  I would like to state, though, that my GERD has come back somewhat.  I still get heartburn, but never to the degree I once had.  I just wanna make it clear, though, despite being told otherwise, it is not because I’ve stretched my pouch out beyond repair or because my stoma is the size of the Grand Canyon.  It’s cause I’m special, damnit.  I’m a lemon, and don’t you forget about it.

BTW — hello Medscape?  You have many typos on your dates today.  You should correct that, given, you know, that you are an important resource to us peeps out here in the interwebz.

From Medscape:

Gastric Bypass Relieves GERD Syndromes in Most Obese Patients

By Michelle Rizzo

NEW YORK (Reuters Health) Jan 08 – Gastric bypass alleviates gastroesophageal reflux disease (GERD) in most obese patients and provides “substantial” improvement in heartburn by 6 months after surgery, report researchers from Brazil in the December 10th online issue of the Annals of Surgery.

Obese GERD patients also have an improved quality of life after gastric bypass, and they use fewer proton pump inhibitors, senior author Dr. Fernando Fornari, from the University of Passo Fundo, told Reuters Health.

“GERD is highly prevalent in patients with morbid obesity, contributing to compromise the quality of life of these patients,” Dr. Fornari noted. “In the last 50 years, the conventional surgical treatment for GERD has been a gastric fundoplication.”

However, he added, GERD symptoms often recur after gastric fundoplication in obese patients.

In their study, he and his colleagues followed 86 morbidly obese patients who were evaluated for GERD symptoms before and 6 months after their gastric bypass operations.

Overall, the mean age was 38 years, the mean preoperative body mass index was 45.3, 25 patients were male, and most (n=84) were white Brazilians.

The overall prevalence of GERD was 64% before gastric bypass and 33% at 6 months after the surgery (p < 0.0001).

Forty-seven patients had typical reflux syndrome before surgery, which resolved in 39. Of the 39 patients without preoperative reflux syndrome, 4 developed symptoms postoperatively.

The chief complaint before surgery was heartburn (in 96%); after surgery, it was regurgitation (in 64%).

After gastric bypass, the esophageal mucosa was improved in 27 patients, unchanged in 51 patients, and worse in 8 patients. Postoperatively, the number of patients with extra-esophageal injury was reduced from 16 to 1.

There was also a significant decrease in acid exposure in the overall population, from a median of 5.1% before surgery to 1.1% afterward.

After surgery, 74 patients had a pH below 4 in their gastric pouch. Although there was no difference in typical reflux syndrome symptoms in patients with or without an acid gastric pouch (18% versus 8%), reflux esophagitis was more frequent with an acid gastric pouch (26% versus 0%; p = 0.041).

“Based on our study, we believe that gastric bypass may replace the conventional surgical technique for patients with morbid obesity who suffer from GERD,” Dr. Fornari noted. “In addition, it is well established that gastric bypass increases both quantity and quality of life by treating obesity and its related comorbidities.”

He and his colleagues conclude, “Whether regurgitation post-gastric bypass corresponds to reflux disease or bad eating behavior deserves further studies.”

Ann Surg 2009.