Incidence of GERD, Esophagitis, Barrett’s Esophagus, and Esophageal Adenocarcinoma after Bariatric Surgery

Abstract Setting Some bariatric procedures have been associated with increased Gastroesophageal Reflux Disease (GERD) symptoms, however there is limited data on the long-term changes to the esophagus across bariatric procedures, and how preoperative esophageal disease is impacted by bariatric surgery. Objectives To estimate incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma before and after bariatric surgery and to identify potential risk factors for these conditions. Methods Retrospective analysis of New York State Database (SPARCS). Adult patients undergoing bariatric surgery (Roux-en-Y gastric bypass, adjustable gastric banding, laparoscopic sleeve gastrectony, and biliopancreatic diversion) from 1995-2010. Multivariable Cox proportional hazard models were used to examine the association between pre-operative diagnosis, surgery type, and post-operative diagnosis. Results A total of 48,967 records were analyzed. 30.3% had a diagnosis of GERD at the time of surgery and 0.4% had a diagnosis of esophagitis and Barrett's. Preoperative GERD/esophagitis/Barrett's was associated with higher risk of GERD, esophagitis, and Barrett's, but not esophageal adenocarcinoma, post-operatively. Roux-en-Y gastric bypass patients had lowest risk of being diagnosed with GERD post-operatively. Overall esophageal adenocarcinoma incidence in the sample was 0.04%; the rate among patients with pre-operative GERD and Barrett's was 0.1% and 0.9%, respectively. Incidence of esophageal adenocarcinoma did not differ by bariatric surgery type. Conclusions Preoperative diagnosis is a risk factor for postoperative esophageal disease following bariatric surgery. Adjustible gastric banding and laparoscopic sleeve gastrectomy are associated with higher risk of postop GERD and esophagitis compared to Roux-en-Y gastric bypass. Incidence of esophageal adenocarcinoma did not differ by surgery type.