Background

Gastroesophageal reflux disease (GERD) is a common comorbidity with increased incidence and severity among patients with obesity. Sleeve gastrectomy is the most frequently performed bariatric surgery in the United States and is known to cause de novo GERD in up to 21% of patients. This study aimed to evaluate if pre-operative Hill classification (used to evaluate the lower esophageal sphincter or LES) was related to the incidence of de novo GERD after sleeve gastrectomy.

Methods

Forty patients were enrolled into this pilot study in 2019. Patients had pre-operative upper endoscopy to evaluate the LES prior to sleeve gastrectomy. Patients completed the GerdQ questionnaire pre-operatively, at three months, and one-year post-operatively. Patients were divided according to Hill classification and analyzed using Pearson Chi-square.

Results

Eight patients were Hill I, fourteen patients were Hill II, and nine patients were Hill III. Hill II patients were more likely to require over the counter (OTC) medications for GERD one-year post-operatively. Of Hill II patients, two were taking OTC medications weekly and six patients were taking OTC medications 4-7 times weekly. 42.9% of patients in the Hill II group did not require OTC medications, this was a significant difference from the Hill I and III groups (p = 0.023).

Conclusions

In this pilot study, patients with Hill II have increased symptoms of GERD. Future studies could confirm these findings with pH monitoring and subsequent upper endoscopy to evaluate for clinical signs of GERD. In hopes to improve patient selection for sleeve gastrectomy.