Persistent Gastroesophageal Reflux Disease After RYGB: What Shall we do Next?

Background: Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications.

Methods: This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication.

Results: Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population.

Conclusion: There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.