Mild to Moderate GERD before Sleeve: Can we Better Predict Post-Operative GERD?
Justine Chinn, MD, Mark Shacker, BS, Perisa Ruhi-Williams, MD, Micaela Esquivel, MD, FACS, Daniel Azagury, MD, FACS
Introduction: New onset or worsening gastro-esophageal reflux disease (GERD) has been typically reported after sleeve gastrectomy (SG). We sought to characterize what preoperative Bravo pH testing findings were associated with the development or persistence of GERD after SG.
Methods: A cohort of patients with history of SG who had undergone preoperative Bravo pH studies were identified. Abnormal DeMeester score was defined as > 14.7. Abnormal acid exposure time (AET) was defined as >4% of time with a pH <4. Post-operative GERD was defined as GERD requiring Proton Pump Inhibitor (PPI). We performed a univariate analysis. We performed a Youden’s index analysis to determine the threshold for which DeMeester score and AET predict post-operative GERD.
Results: A total of 76 patients were included, with 53% reporting preoperative GERD. Of those with symptoms, there was no difference in the rate of post-operative PPI use between those with a normal vs abnormal preoperative Demeester (13.3% vs 13.0%, p>0.9). In univariate analysis, abnormal DeMeester score (OR 1.25, p=0.779), esophagitis (OR=1.70, p=0.554), or abnormal AET (OR=1.25, p=0.779) were not predictive of post-operative GERD. However, a threshold of DeMeester score of ≥30 or AET ≥10.35 was predictive of post-operative GERD.
Conclusion: In patients with moderate GERD, standard cut-offs of abnormal DeMeester score and AET were not predictive of post-operative GERD. Even in patients with abnormal Demeester and AET, the rates of post-operative PPI use were similar to those with normal studies. However, a threshold of DeMeester score of ≥30 or AET ≥10.35 was predictive of post-operative GERD.