GERD After Sleeve Gastrectomy Related to Proximal Gastric Pressurization

GERD After Sleeve Gastrectomy Related to Proximal Gastric Pressurization

Prateek Sharma, MD, FASGE, reviewing Greenan G, et al. Am J Gastroenterol 2023 Jun 19.

Sleeve gastrectomy (SG) has become a popular choice for weight loss due to its ease and effectiveness. However, it can worsen symptoms of esophageal reflux and lead to the development of gastroesophageal reflux disease (GERD). This study evaluated the effects of bariatric surgery on patients who underwent SG or Roux-en-Y gastric bypass (RYGB) versus nonsurgical patients and asymptomatic controls. It specifically focused on the patterns and consequences of pressurization of the proximal stomach, using high-resolution manometry (HRM) in these patients.

The study included patients who underwent HRM and ambulatory pH-impedance monitoring after SG (n=36) or RYGB (n=23) and symptomatic (n=113) and asymptomatic (n=15) control patients. The investigators found that both SG and RYGB patients experienced pressurization of the stomach during swallows and a straight leg raise maneuver. However, compared with RYGB, SG resulted in higher acid exposure time (AET; median, 6.0% vs 0.2%) and more reflux episodes (63.0 vs 37.5). Patients who underwent SG also had higher baseline intragastric pressure and lower trans-esophagogastric junction (EGJ) pressure gradients during pathological reflux. Multivariable analysis showed that SG and a low EGJ contractile integral were independently associated with increased AET and reflux episode numbers.

Prateek Sharma, MD, FASGE


Gastroesophageal reflux, particularly during strain maneuvers, is linked to compromised barrier function at the EGJ and increased pressure in the proximal stomach following sleeve gastrectomy.


Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Greenan G, Rogers BD, Gyawali CP. Proximal gastric pressurization following sleeve gastrectomy associates with gastroesophageal reflux. Am J Gastroenterol 2023 Jun 19. (Epub ahead of print) (

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