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Background <p>Sleeve gastrectomy (SG) is a common metabolic and bariatric surgery (MBS) with conflicting effects on gastroesophageal reflux disease (GERD), with some patients improving and others experiencing new or worsened GERD. This study investigated whether preoperative ambulatory 24-h pH monitoring (24-h pH) predicts postoperative GERD in patients undergoing SG, comparing GERD outcomes among those with normal, abnormal, and without preoperative 24-h pH.</p> Methods <p>A retrospective study was conducted on 120 patients (88.3% women, 38 ± 9&#xa0;years, preoperative BMI 38.0 [36.4–40.6] kg/m<sup>2</sup>) who underwent SG between January 2017 and March 2022. Patients were subjected to clinical evaluation, including physical examination and anthropometric assessment, as well as upper gastrointestinal endoscopy (UGIE) at baseline and 12&#xa0;months postoperatively. Preoperative 24-h pH was performed in a subset of patients, who were classified as normal (NG), abnormal (AG), and no monitoring (NMG) groups. Furthermore, GERD symptoms were evaluated postoperatively through the GERD questionnaire (Gerd-Q).</p> Results <p>At 12&#xa0;months, the groups had a similar proportion of normal UGIE findings. Grade B esophagitis occurred in 7.5% of the NG vs. 25% of the AG. The NG exhibited lower Gerd-Q total scores and a smaller proportion of positive results compared with the NMG and the AG (2 [0–5] vs. 7 [0.5–18] and 5 [2–11.75]; 12.5% vs. 47.5% and 47.5%, respectively; <i>p</i> &lt; 0.05 for all variables).</p> Conclusion <p>Postoperative GERD was more frequent in patients with abnormal or those without preoperative 24-h pH monitoring, whereas those with normal results in this test exhibited lower rates. These findings raise an important discussion regarding the role of 24-h pH monitoring before SG and its impact on clinical decision-making.</p>

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Searching for the Perfect Sleeve Gastrectomy: The Role of Preoperative pHmetry in the Incidence of Postoperative Reflux Disease

  • 期刊论文

  • 发表日期：

    2026年1月22日

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  • Gabriela Carolina Loayza Mosquera,
  • Karynne Grutter Lopes,
  • Miguel de Miranda Gonçalves,
  • Paulo Roberto Falcão Leal,
  • Luiz Guilherme Kraemer-Aguiar

摘要

Background

Sleeve gastrectomy (SG) is a common metabolic and bariatric surgery (MBS) with conflicting effects on gastroesophageal reflux disease (GERD), with some patients improving and others experiencing new or worsened GERD. This study investigated whether preoperative ambulatory 24-h pH monitoring (24-h pH) predicts postoperative GERD in patients undergoing SG, comparing GERD outcomes among those with normal, abnormal, and without preoperative 24-h pH.

Methods

A retrospective study was conducted on 120 patients (88.3% women, 38 ± 9 years, preoperative BMI 38.0 [36.4–40.6] kg/m2) who underwent SG between January 2017 and March 2022. Patients were subjected to clinical evaluation, including physical examination and anthropometric assessment, as well as upper gastrointestinal endoscopy (UGIE) at baseline and 12 months postoperatively. Preoperative 24-h pH was performed in a subset of patients, who were classified as normal (NG), abnormal (AG), and no monitoring (NMG) groups. Furthermore, GERD symptoms were evaluated postoperatively through the GERD questionnaire (Gerd-Q).

Results

At 12 months, the groups had a similar proportion of normal UGIE findings. Grade B esophagitis occurred in 7.5% of the NG vs. 25% of the AG. The NG exhibited lower Gerd-Q total scores and a smaller proportion of positive results compared with the NMG and the AG (2 [0–5] vs. 7 [0.5–18] and 5 [2–11.75]; 12.5% vs. 47.5% and 47.5%, respectively; p < 0.05 for all variables).

Conclusion

Postoperative GERD was more frequent in patients with abnormal or those without preoperative 24-h pH monitoring, whereas those with normal results in this test exhibited lower rates. These findings raise an important discussion regarding the role of 24-h pH monitoring before SG and its impact on clinical decision-making.