Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: The burning questions

Table 2 Putative pathophysiological mechanisms of gastroesophageal reflux disease post laparoscopic sleeve gastrectomy

Hypotensive lower esophageal sphincter[48]

Loss of angle of His flap valve[55]

Increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach[56]

Reduction in the compliance of the gastric remnant provoking an increase in transient lower esophageal sphincter relaxations[57]

Lack of gastric compliance and emptying during the first postoperative year[58]

Relative gastric stasis in the proximal remnant and increased emptying from the antrum (suggested on time-resolved MRI studies)[59]

Excessively large or dilated sleeve retaining increased acid production capacity leading to reflux[60]

Overly narrowed or strictured sleeve resulting in reflux and decreased esophageal acid clearance[61]

MRI: Magnetic resonance imaging.