Opinion Review
Copyright ©The Author(s) 2019.
World J Gastroenterol. Sep 7, 2019; 25(33): 4805-4813
Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4805
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]