Background

To compare the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on gastroesophageal reflux disease (GERD) one year after surgery.

Methods

Patients with type 2 diabetes and severe obesity were included in the triple blinded randomized Obesity surgery in Tønsberg (Oseberg) trial (2013-2018) and randomly allocated to SG or RYGB. GERD-symptoms, esophagitis and pathological acid reflux were assessed with the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire where a reflux score ≥20 was defined as marked reflux symptoms, esophagogastroduodenoscopy (Los Angeles Classification), and 24-hour pH-monitoring (DeMeester score cut-off ≥14.72), respectively.

Results

A total of 109 patients (69 female), mean (SD) age 47.6 (10.4) years and BMI 42.3 (5.2) kg/m2, were randomized and allocated in a 1:1 ratio to SG (n=55) or RYGB (n=54), and 93 patients (85%) completed 1-year follow up. At 1-year, the proportion of patients with GSRS ≥20 was 16% and 4% in the SG and RYGB group, respectively (p=0.046). The prevalence of erosive esophagitis was 49% versus 34%, respectively (p=0.15). The prevalence of de novo-esophagitis was higher in the SG-group, 47% versus 13%, p=0.017. The mean (SD) DeMeester score was higher in the SG-group than in the RYGB-group 23 (27) versus 10 (15), p=0.008, and the proportion of patients with pathological acid reflux was higher in the SG-group, 49% versus 15%, p=0.001.

Conclusions

One year after surgery, patients who underwent SG had significantly higher prevalence of GERD-symptoms, pathological acid reflux and de novo esophagitis than those who underwent RYGB.