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

## TL;DR

This review examines how common bariatric surgeries affect the risk of GERD and Barrett’s esophagus, finding that sleeve gastrectomy may increase BE risk while Roux-en-Y bypass may protect against it.

## Contribution

The study highlights the need for high-quality, long-term research to clarify the effects of bariatric procedures on Barrett’s esophagus.

## Key findings

- Sleeve gastrectomy is associated with a higher risk of Barrett’s esophagus compared to the general population.
- Roux-en-Y gastric bypass appears to protect against Barrett’s esophagus.
- Other bariatric procedures lack sufficient data and require further investigation.

## Abstract

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.

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.

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

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.

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.

It is well established that obese patients experience more severe esophagitis and Barrett’s esophagus (BE) than individuals of normal weight;

Bariatric procedures, designed to reduce excess weight, are expected to positively impact the prevention of gastroesophageal reflux disease and BE;

Current evidence suggests that the incidence of BE is higher following laparoscopic sleeve gastrectomy compared to the general population. This review provides compelling evidence that LSG may indeed lead to an increased risk of BE;

Numerous studies suggest that Roux-en-Y gastric bypass protects against BE.

Literature on Barrett’s esophagus (BE) after bariatric procedure presents wide variation, and many studies have bias and limitations. In all reported cases, sleeve gastrectomy appears to promote gastroesophageal reflux disease and the potential development of BE, in contrast to Roux-en-Y gastric bypass (RYGB). Scarce and low-quality information is available regarding the other bariatric procedures.

Current evidence suggests that the incidence of Barrett’s esophagus (BE) is higher following laparoscopic sleeve gastrectomy (LSG) compared to the general population. This review provides compelling evidence that LSG may indeed lead to an increased risk of BE. Numerous studies suggest that Roux-en-Y gastric bypass (RYGB) protects against BE. To fully understand the effect of bariatric surgery on BE, other bariatric procedures must be extensively assessed in well-controlled prospective studies with long-term follow-up (FU).