Reflux nach bariatrischen Operationen

Obesity and gastro-esophageal reflux disease (GERD) are two of the major health problems of the industrialized world. Both condition have increased prevalence, pathophysiological and endoscopic studies identified obesity a major risk factor in the development of GERD. Conversely, successful weight reduction improves GERD symptoms and diminishes the use of acid suppressive medication. Bariatric interventions are not all equal when it comes to controlling GERD symptoms, lesions and use of medication. Gastric banding has a variable influence on GERD, while most patients report improved reflux symptoms, up to 20% of patient can develop "de novo" reflux symptoms following gastric banding. Gastric sleeve resection increases reflux symptoms, in particular in patients with an ideal, tubular gastroplasty and those with proximal (fundic) pouch. Roux-en-Y gastric bypass has a positive effect of GERD, reducing symptoms and use of acid suppressive medications. From an esophageal perspective, gastric bypass is the preferred bariatric procedure to treat and prevent GERD in morbidly obese patients.

Epidemiologische, pathophysiologische und endoskopische Studien belegen die positive Assoziation zwischen GERD und Adipositas. Von den bariatrischen Eingriffen hat das Magenband einen nicht vorhersehbaren Einfluss auf den gastro-ösophagealen Reflux (bei manchen Patienten führt das Magenband zu einer Abnahme des gastro-ösophagealen Refluxes, andere hingegen entwickeln neu Reflux Symptome), die Magenteilresektion führt zu einer Zunahme des gastro-ösophagealen Refluxes und der Roux-en-Y Magenbypass reduziert GERD-Symptome und Bedarf an säurehemmender Therapie. Aus ösophagealer Perspektive ist der Roux-en-Y Magenbypass die bariatrische Operation der Wahl.