Gastroesophageal reflux disease (GORD) post-sleeve gastrectomy (SG) is a controversial issue and diagnostic dilemma. Strong heterogeneity exists in the assessment of reflux post-SG and better diagnostic tools are needed to characterise symptomatic reflux. We aimed to determine discriminatory factors of symptomatic reflux and establish diagnostic thresholds for OERD following SG.
Patients who underwent SG, categorised into asymptomatic and symptomatic cohorts, completed validated symptom questionnaires. Stationary oesophageal manometry and 24-hour ambulatory pH monitoring were performed. Univariate and multivariate analyses were conducted to determine the strongest discriminators for GORD.
Baseline characteristics of the asymptomatic cohort (n=48) and symptomatic cohort (n=76) were comparable: age 47.6 ± 11.6 vs 44.1 ± 11.4 years (p=0.103), pre-operative BMI 47.5 ± 7.2 vs 45.6 ± 8.0kg/m2 (p=0.188), excess weight loss 53.2 ± 27.4 vs 55.5 ± 25.4% (p=0.650), time from surgery 7.3 (14.1) vs 7.5 (10.7) months (p=0.825). The symptomatic cohort was more female-predominant (90.8 vs 72.9%, p=0.008). Reflux scores were significantly higher in the symptomatic group (36.0 vs 10.5, p=0.003). Stationary manometry parameters were similar, including hiatus hernia prevalence and impaired oesophageal motility. The symptomatic cohort had significantly higher total acid exposure, especially while supine (11.3% vs 0.6%, p<0.001). Univariate and multivariate regressions delineated reflux score and supine acid exposure as discriminatory factors for symptomatic reflux. Thresholds for distinguishing symptomatic reflux: reflux score of 11.5 (sensitivity 84.0%, specificity 68.2%) and supine acid exposure of 2.65% (sensitivity 67.1%, specificity 70.8%).
We have demonstrated the significance of a validated patient-reported reflux score and 24-hour ambulatory pH in defining symptomatic reflux following SG.