Abstract
Background
Gastroesophageal reflux (GERD) is common among patients with obesity who undergo bariatric
surgery. Although gastric bypass and sleeve gastrectomy are the most common bariatric
operations performed in the United States, their long-term comparative effectiveness
on GERD medication use is unknown.
Objective
To compare the long-term effectiveness of gastric bypass and sleeve gastrectomy on
use of antireflux medication.
Setting: National cohort undergoing inpatient bariatric surgery.
Methods
This is a retrospective study of Medicare beneficiaries undergoing gastric bypass
and sleeve gastrectomy between January 1, 2012, and December 31, 2017. A difference-in-differences
analysis was conducted to evaluate the differential change in antireflux medication
use between groups before and after surgery.
Results
A total of 16,640 patients underwent gastric bypass, and 26,724 patients underwent
sleeve gastrectomy. Before surgery, GERD medication use was higher among patients
who underwent gastric bypass (62.4%; 95% confidence interval [CI]: 62.0%–63.7%) compared
with patients who underwent sleeve gastrectomy (60.1%; 95% CI: 59.3%–60.9%). Five
years after surgery, GERD medication use was lower in patients who underwent gastric
bypass (47.8%; 95% CI: 46.3%–49.3%) compared with patients who underwent sleeve gastrectomy
(53.7%; 95% CI: 50.5%–56.9%). The differential decrease from baseline GERD medication
use was greater for patients who underwent gastric bypass at 2 years (–4.1 percentage
points [pp]; 95% CI: –1.7 to –6.5 pp), 3 years (–4.3 pp; 95% CI: –1.6 to –7.0 pp),
4 years (–6.9 pp; 95% CI: –4.1 to –9.6 pp), and 5 years (–8.3 pp; 95% CI: –3.7 to
12.8 pp) after surgery.
Conclusion
Though use of antireflux medication decreased following both procedures, gastric bypass
was associated with a greater reduction in antireflux medication use 5 years after
surgery compared with sleeve gastrectomy. Understanding the long-term comparative
effectiveness of these common bariatric operations may better inform treatment decisions
among patients and surgeons.
Key words
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Article info
Publication history
Published online: April 22, 2022
Accepted:
April 17,
2022
Received:
January 7,
2022
Identification
Copyright
© 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
