Impact of Sleeve Gastrectomy on Esophageal Physiology and Gastro-Esophageal Reflux Disease: A Bicentric Prospective Study

Abstract

Background: Obesity is associated with gastroesophageal reflux disease and esophageal dysmotility. Bariatric surgerieslike laparoscopic sleeve gastrectomy (LSG) aid weight loss but can affect esophageal function. This study examines theimpact of LSG on esophageal physiology, especially concerning reflux.Patients and methods: This prospective study, conducted between 2022 and 2023 in Egypt and Italy, involved 15 patients with severe obesity who had undergone LSG. The study used conventional esophageal manometry, 24-hour impedancepH monitoring, upper gastrointestinal series, gastroscopy, and a validated questionnaire pre and postoperatively to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux.Results: The study group after 1 year experienced significant reductions in weight and BMI, with P values less than0.001 for both measures. Gastroesophageal reflux disease symptoms remained unchanged postoperatively (P=0.687) with26.7% using proton pump inhibitors before and after surgery, and quality of life improved significantly, with a P value of0.001. No significant changes were detected in the esophagogastroduodenoscopy, barium studies, and the metrics of themultichannel intraluminal impedance-pH monitoring. Regarding the manometric parameters, significant changes wereobserved as the total LES length decreased from 34.0 to 31.33 mm (P=0.027), LES residual pressure increased from 2.0to 4.0 mmHg (P=0.012), and esophageal peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (P<0.001).Conclusions: LSG is effective for weight loss and improving the quality of life. It controls reflux, with new cases beinguncommon. Advanced diagnostics are key when standard tests are insufficient.