Predictors of Poor Quality of Life in Patients with Gastroesophageal Reflux Disease Undergoing Sleeve Gastrectomy.

Background -Gastroesophageal reflux disease (GERD) is commonly diagnosed in patients with severe obesity. The outcomes of patients with preoperative GERD after sleeve gastrectomy (SG) are unclear, and some surgeons consider GERD a contraindication for SG. Methods -A retrospective analysis of a tertiary university hospital database was conducted. All patients with preoperative GERD undergoing SG between January 2012 and January 2020 and having at least two years of follow-up were included in the analysis. A validated GERD-associated quality of life questionnaire (GERD-HRQL) was completed by all patients. Results -During the study period, 116/1985 patients (5.8%) were diagnosed with GERD before SG. In total, 55 patients were available for a two-year follow-up and were included in the analysis. Median follow-up was 40 months (range 24-156 months). Mean total weight loss (TWL) was 24.0% ± 12.0%. On follow-up, 43 patients (78.1%) reported having GERD symptoms. In patients who underwent postoperative endoscopy, less than a third had esophagitis. The mean GERD-HRQL score was 25.2 ± 10.9. On univariable analysis, patients with poor GERD-HRQL had lower BMI at baseline (41.5 ± 12.4 vs. 44.9 ± 10.0 kg/m ² , p = 0.03), were less commonly smokers at baseline (8.1% vs. 33.3%, p = 0.02), and had lower TWL at the end of the follow-up (22.2% ± 10.4% vs. 28.9% ± 13.7%, p = 0.05). On multivariable analysis, smoking status at baseline and TWL at last follow-up were independent predictors of better GERD-HRQL. Conclusions -In conclusion, most GERD patients after SG have a relatively high GERD-HRQL score, most patients still have GERD symptoms during the follow-up, and approximately a third of patients have endoscopic signs of esophagitis. There was an association between patients with higher TWL and smoking at baseline and better GERD-HRQL outcomes. The latter is potentially due to smoking cessation.