A NEW prospective study has found that Roux-en-Y gastric bypass (LRYGB) is more effective than sleeve gastrectomy (LSG) at improving gastroesophageal reflux disease (GERD) and oesophageal physiology, offering important guidance for surgical decision-making in patients with severe obesity.
Conducted in Turin, Italy, the study followed 30 bariatric patients, 15 undergoing LSG and 15 undergoing LRYGB, using a combination of oesophageal manometry, 24-hour pH impedance monitoring, endoscopy, and quality-of-life surveys before and one year after surgery.
Both procedures resulted in significant weight loss, with LRYGB producing a greater percentage of excess weight loss. However, the impact on GERD and oesophageal function differed markedly between the two groups.
In the LSG group, reflux symptoms and proton pump inhibitor (PPI) use remained largely unchanged after surgery. Conversely, the LRYGB group experienced a dramatic reduction in reflux symptoms, PPI use (from 53.3% to 6.7%), and esophagitis rates. Objective reflux markers also improved significantly in this group, with reductions in total and acidic reflux episodes and in the DeMeester score.
Manometry results showed that LSG affected several oesophageal pressure parameters, including a decrease in peristaltic wave amplitude, whereas LRYGB had minimal impact aside from a modest increase in lower oesophageal sphincter (LES) residual pressure.
The findings underscore that while both LSG and LRYGB are effective for long-term weight loss and quality of life, LRYGB offers additional benefits for patients with reflux or oesophageal dysfunction. The study also highlights the importance of advanced diagnostics for tailoring surgical approaches when reflux is a concern.
Aleksandra Zurowska, EMJ
Reference
Mansour A et al. Impact of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Esophageal Physiology and Gastroesophageal Reflux Disease: A Prospective Study. OBES SURG. 2025; DOI: 10.1007/s11695-025-07818-4.
