The following is a summary of “Proximal Gastric Pressurization After Sleeve Gastrectomy Associates With Gastroesophageal Reflux,” published in the December 2023 issue of Gastroenterology by Greenan, et al.

Sleeve gastrectomy (SG) results in persistent or newly developed reflux more frequently than Roux-en-Y gastric bypass (RYGB). For a study, researchers sought to investigate pressurization patterns in the proximal stomach using high-resolution manometry (HRM) and determine their associations with reflux following SG.

The study included patients who underwent HRM and ambulatory pH-impedance monitoring after SG and RYGB between 2019 and 2020. Symptomatic control patients with HRM and pH-impedance monitoring for reflux symptoms were identified for each included patient, along with 15 asymptomatic healthy controls with HRM studies. Exclusions were made for concurrent myotomy and a preoperative diagnosis of obstructive motor disorders. Various HRM metrics, esophagogastric junction (EGJ) pressures, contractile integral (EGJ-CI), acid exposure time (AET), and reflux episode numbers were extracted. Intragastric pressure was sampled at baseline, during swallows, and with the straight leg raise maneuver and compared with intraesophageal pressure and reflux burden.

The patient cohorts included 36 SG patients, 23 RYGB patients, 113 symptomatic controls, and 15 asymptomatic controls. While both SG and RYGB patients exhibited stomach pressurization during swallows and the straight leg raise, SG patients showed higher AET (median 6.0% vs. 0.2%), reflux episode numbers (median 63.0 vs. 37.5), and baseline intragastric pressure (median 17.3 mm Hg vs. 13.1 mm Hg) (P < 0.001). SG patients also had lower trans-EGJ pressure gradients during reflux episodes >80 or AET >6.0% (P = 0.018 and 0.08, respectively, compared to no pathologic reflux). Multivariable analysis revealed that SG status and low EGJ-CI were independent associations with AET and reflux episode numbers (P ≤ 0.04).

The impaired barrier function of the esophagogastric junction (EGJ) and proximal gastric pressurization after SG were linked to gastroesophageal reflux, particularly during strain maneuvers.

Source: journals.lww.com/ajg/abstract/2023/12000/proximal_gastric_pressurization_after_sleeve.17.aspx