Reflux After Bariatric Surgery: Incidence and Workup

The reported incidence of reflux after weight loss surgery is varied. In this chapter, the literature is reviewed at length. Additionally, several evaluation algorithms have been proposed. The purpose of each evaluation and how it contributes to management strategies will be explored. Esophagogastroduodenoscopy (EGD) provides a direct view of the gastroesophageal junction, assesses esophageal mucosa, and allows for anatomic evaluation. Manometry aids in the evaluation of esophageal function objectively and determines lower esophageal sphincter (LES) dysfunction. The upper gastrointestinal (UGI) series offers valuable insights into reflux quantification, and anatomic changes, and is particularly helpful for evaluating sleeve morphology. Bravo pH monitoring and impedance testing offers objective data for correlating symptoms with reflux events, aiding in diagnosis and treatment decisions. Endoflip is gaining popularity as a part of the evaluation strategy. In summary, understanding and managing reflux after bariatric surgery requires a multifaceted approach, taking into consideration the type of surgery, patient characteristics, and a range of diagnostic tools to provide tailored solutions for GERD.