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World J Gastroenterol. Aug 14, 2010; 16(30): 3757-3761
Published online Aug 14, 2010. doi: 10.3748/wjg.v16.i30.3757
Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery?
Vivek N Prachand, John C Alverdy
Vivek N Prachand, John C Alverdy, Center for the Surgical Treatment of Obesity, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Author contributions: Prachand VN wrote the manuscript; Alverdy JC provided critical revisions.
Correspondence to: Vivek N Prachand, MD, Co-Director, Center for the Surgical Treatment of Obesity, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 5036, Room G 203, Chicago, IL 60637, United States. vprachan@surgery.bsd.uchicago.edu
Telephone: +1-773-7020190 Fax: +1-773-8343204
Received: April 24, 2010
Revised: June 7, 2010
Accepted: June 14, 2010
Published online: August 14, 2010
Abstract

Increases in the prevalence of obesity and gastroesophageal reflux disease (GERD) have paralleled one another over the past decade, which suggests the possibility of a linkage between these two processes. In both instances, surgical therapy is recognized as the most effective treatment for severe, refractory disease. Current surgical therapies for severe obesity include (in descending frequency) Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, while fundoplication remains the mainstay for the treatment of severe GERD. In several large series, however, the outcomes and durability of fundoplication in the setting of severe obesity are not as good as those in patients who are not severely obese. As such, bariatric surgery has been suggested as a potential alternative treatment for these patients. This article reviews current concepts in the putative pathophysiological mechanisms by which obesity contributes to gastroesophageal reflux and their implications with regards to surgical therapy for GERD in the setting of severe obesity.

Keywords: Morbid obesity; Gastroesophageal reflux disease; Fundoplication; Bariatric surgery; Gastric bypass; Sleeve gastrectomy