Impact of diabetes and bariatric surgery on gastroesophageal reflux disease and patient- reported outcomes: A cross-sectional study of patients with and without type 2 diabetes, and a randomized study (Oseberg) comparing the short-and medium term effects of gastric bypass and sleeve gastrectomy on gastroesophageal reflux disease and patient-reported outcomes
Abstract
Obesity and type 2 diabetes (T2D) are associated with increased risk of gastroesophageal reflux disease (GERD) which may cause serious health problems like esophagitis, ulcers, strictures, Barrett’s esophagus and esophageal adenocarcinoma. Roux-en-Y gastric bypass (RYGB) is considered an effective anti-reflux procedure, while sleeve gastrectomy (SG) may induce or worsen GERD. The main objectives of this thesis were, first, to assess the impact of T2D on GERD and, second, to compare the effects of SG and RYGB on GERD and clinically important patient-reported outcomes in patients with severe obesity. We hypothesized that bariatric surgery candidates with T2D had a higher proportion of GERD than those without T2D, and that patients who underwent SG would have a higher 1-year risk of GERD and lower improvement in weight-related quality of life, remission of diabetes and weight loss. Symptoms were measured with validated questionnaires, and objective testing included esophagogastro-duodenoscopy, 24-hour pH monitoring and high-resolution manometry. The results showed that the 1-year prevalence of symptomatic GERD did not differ significantly between groups with or without T2D (28% vs 18%), and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2D. SG was associated with a substantially higher 1-year risk of acid reflux and new-onset esophagitis than RYGB, but, irrespective of group, few patients reported GERD-symptoms. At 3 years, RYGB was superior to SG regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about expected outcomes after the surgical procedures and may add knowledge to existing policies and guidelines.List of papers
Paper 1. Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study. Jolanta Lorentzen, Asle W. Medhus, Jens Kristoffer Hertel, Heidi Borgeraas, Tor-Ivar Karlsen, Ronette L. Kolotkin, Rune Sandbu, Daniel Sifrim, Marius Svanevik, Dag Hofsø, Birgitte Seip, Jøran Hjelmesæth. Obes Surg. 2020 Jul; 30 (7):2667-2675. PMID:32193740. DOI: 10.1007/s11695-020-04545-w. The paper is included in the thesis. Also available at: https://doi.org/10.1007/s11695-020-04545-w |
Paper 2. Sleeve Gastrectomy Confers Higher Risk of Gastroesophageal Reflux Disease Than Gastric Bypass: A Randomized Controlled Trial From the Oseberg Reflux Working Group. Jolanta Lorentzen, Asle W. Medhus, Dag Hofsø, Marius Svanevik, Birgitte Seip and Jøran Hjelmesæth. Gastroenterology. 2021 Dec;161(6):2044-2046. e4. doi: 10.1053/j.gastro.2021.08.021. Epub 2021 Aug 20. PMID: 34419459. DOI: 10.1053/j.gastro.2021.08.021. The paper is included in the thesis. Also available at: https://doi.org/10.1053/j.gastro.2021.08.021 |
Paper 3. Patient-reported outcomes, weight loss and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre randomised controlled trial. Marius Svanevik, Jolanta Lorentzen, Heidi Borgeraas, Rune Sandbu, Birgitte Seip, Asle Wilhelm Medhus, Jens Kristoffer Hertel, Ronette L. Kolotkin, Milada C. Småstuen, Dag Hofsø and Jøran Hjelmesæth. The Lancet Diabetes & Endocrinology 2023, vol 11(8): 555–566. DOI: 10.1016/S2213-8587(23)00127-4. The paper is included in the thesis. Also available at: https://doi.org/10.1016/S2213-8587(23)00127-4 |