The effect of sleeve gastrectomy on extraesophageal reflux disease

Abstract

Background: Sleeve gastrectomy (SG) has been linked to increased rates of postoperative gastroesophageal reflux.

Objective: The aim of this study was to evaluate whether SG is also linked to increased pulmonary extraesophageal reflux disease in a rodent model, based on histologic inflammatory distal airway changes.

Setting: University hospital.

Methods: Wistar rats (Charles River Institute, Wilmington, MA) were fed a high fat diet (HFD) for 4 months. They were divided into HFD only (n = 25) and SG+HFD (n = 19) groups and euthanized at 12 weeks, and the trachea and lungs were harvested en bloc then preserved for analysis by a blinded board-certified pathologist.

Results: Rats who underwent SG were significantly less likely to show postmortem distal airway changes (4.0% versus 31.0%, P = .03), had a lower average chronic aspiration pneumonitis grade (.73 versus 1.57, P = .006), and had a lower total lung injury score (1.19 versus 2.28, P = .005). Alveolar hemorrhage was also less common in the SG+HFD group (37.5% versus 80.0%, P = .006).

Conclusion: SG is associated with increased incidence of normal lung histology on postmortem examination, less evidence of chronic aspiration pneumonitis and alveolar hemorrhage, and decreased total lung injury score in a rodent model. SG appears to have a protective effect on the pulmonary system. This suggests that SG does not exacerbate extraesophageal reflux effects on the pulmonary epithelium.

Keywords: Bariatric surgery; Extraesophageal reflux; Morbid obesity; Sleeve gastrectomy.