Evolution of GERD symptoms after bariatric surgery: A dose- response meta-analysis

Importance Obesity is associated with increased prevalence of gastroesophageal reflux disease (GERD); with recent reports suggesting improvement in GERD symptoms and weight loss following bariatric surgical intervention. However, the exact impact of the type of bariatric surgery on the evolution of GERD symptoms have remained unexamined. Objective To characterize the exact evolution of GERD symptoms, post bariatric surgery.Data sources We systematically searched electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018) for eligible studies that satisfy pre-specified inclusion criteria. Study selection We included clinical trials of all designs (prospective and retrospective) that reported on GERD outcomes following Laparoscopic Sleeve Gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Data extraction and synthesis Two independent reviewers extracted relevant data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were pooled using a random-effects model.Main outcomes Symptomatic improvement in GERD symptoms following bariatric surgery Results A total of 39 studies were analyzed and a robust-error meta-regression model was used to conduct a Dose-Response Meta-Analysis (DRMA) synthesizing data on 39 studies that reported GERD outcomes after bariatric surgery. Out of 43,994 patients who underwent either LSG (N = 9,547 patients) or LRYGB (N = 34,447 patients), 32.4% experienced improvement in symptoms (95% CI 20.62 to 45.45); The DRMA demonstrated a window period of two years for sustained improvement after which symptoms began to recur in those that were asymptomatic. Conclusion and relevance Bariatric surgery may improve GERD symptoms in obese patients who underwent LSG, however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. The effects were not sustained and returned to baseline within 4 years.