Background

Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure. Anatomic changes induced by LSG have been incriminated in the pathogenesis of GERD. We hypothesized that GERD in LSG can be predicted by measuring the pressure gradient across the esophagus and stomach using the formula∆P α [1 -( re4/ rS4)].

Methods

Over a period of 3 years, 59 patients who underwent LSG were followed up. Measurements were obtained using Gastrographin swallow studies done on post-operative day 1. Patients were assessed for GERD at 3 years using the validated GastroEsophageal Reflux Disease Questionnaire (GERDQ). Cut-off scores of 8 or above were considered as positive for GERD.

Results

Using ROC curve and Youden index, a cut-off of 7.25 was selected for the ratio. Among the 59 included patients, 35 patients had a ratio value less than 7.25. Those below the cut-off had a mean GERDQ score of 8.1 compared to 6.1 in those above the cut-off (p-value <0.001). Among the patients with a value higher than 7.25, none had GERD while 20 patients out of 35 had GERD among the patients with a value below 7.25 (p-value <0.001). Only 42% of patients with a ratio above 7.25 were on PPIs compared to 66% in those above 7.25.

Conclusions

The development of GERD in LSG patients is related to the pressure gradient. Our formula with the cut-off ratio of 7.25 provides a highly specific (100%) and sensitive (61%) test that could predict patients' risk of development GERD.