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New Weight-Loss Surgery May Not Ease Heartburn

Study finds sleeve gastrectomy often doesn't relieve acid reflux, and sometimes makes it worse

WebMD News from HealthDay

By Brenda Goodman

HealthDay Reporter

WEDNESDAY, Feb. 5, 2014 (HealthDay News) -- Obese people who are considering weight-loss surgery should choose their procedure carefully if they hope to be free of chronic heartburn, a new study suggests.

The study of nearly 39,000 patients found that while traditional gastric bypass procedures reduced heartburn and acid reflux symptoms in most sufferers, a newer procedure -- called a laparoscopic sleeve gastrectomy -- was largely unhelpful for those who already had gastroesophageal reflux disease, or GERD. What's more, about 1 in 11 people who didn't have GERD before sleeve gastrectomy developed the condition after their procedure.

The study was published Feb. 5 in the journal JAMA Surgery.

"The fact that this surgery is contributing to reflux is a bit of a wake-up call that we need to at least be a little bit more selective in who is a good candidate for sleeve gastrectomy," said Dr. John Lipham, an associate professor of surgery at the University of Southern California's Keck School of Medicine in Los Angeles. He specializes in treating GERD and diseases of the upper gastrointestinal tract, but was not involved in the current research.

GERD is the backflow of stomach contents into the esophagus, the tube that carries food from the mouth to the stomach. Obesity more than triples the risk for the condition in men, experts say. Obese women face six times the risk.

The backwash of stomach acid and other digestive juices causes heartburn and acid reflux, a burning sensation in the chest and throat. Doctors diagnose GERD when a person has episodes of heartburn at least twice a week or when symptoms interfere with daily life.

The condition isn't merely uncomfortable. Chronic exposure to stomach acid can change the cells lining the esophagus. This can lead to a range of problems from scar tissue that makes it difficult to swallow to cancer.

"The fact of the matter is [GERD] is a serious medical condition and it can lead to a lot of complications," Lipham said.

"Don't get me wrong, I think the sleeve gastrectomy is a good procedure, but it seems best for selected patients without a significant GERD history," he added.

For the study, researchers reviewed the cases of patients who had weight-loss surgery between 2007 and 2010. More than 4,800 patients had sleeve gastrectomies over that period, while nearly 34,000 had gastric bypass procedures.

In a gastric bypass, surgeons make a pouch at the top of the stomach that holds about a cup of food. That pouch is then attached directly to the middle portion of the small intestine, rerouting food past the first section of the gut.

In a sleeve gastrectomy, surgeons remove more than 85 percent of the stomach and shape the remainder into a sleeve or tube, but they don't alter how the food travels through the gut. Weight loss with sleeve gastrectomy is generally slower than gastric bypass, and for some patients, this procedure is the first step before a full bypass.

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