- FRIDAY, Aug. 22 (HealthDay News) — Gastric banding, a surgical
procedure designed to combat obesity, appears to boost the risk for
developing or exacerbating symptoms of gastro-esophageal reflux disease
(GERD).

The finding stems from a review of research on the link between obesity
and reflux. The experts concluded that gastric bypass may help reduce
GERD, but gastric banding does not — a finding patients may want to
consider when choosing one form of weight-loss surgery over another.

“For people with obesity and reflux together, the gastric bypass
procedure appears to be effective not only for weight loss, but also for
the control of reflux symptoms,” concluded the review's lead author, Dr.
Frank K. Friedenberg, an associate professor in the section of
gastroenterology at Temple University School of Medicine, Philadelphia.
“Because in this case, most of the acid from the stomach is being
partitioned away, so it doesn't have exposure to the esophagus,” he
explained.

“However, with gastric banding, the problem is that you actually create
a pocket which acid has the ability to fill from the remainder portion of
the stomach,” Friedenberg said. “And this acid can just sit there above
the band, and make its way back up to the esophagus. This can cause reflux
disease to develop, or make it worse than it had been if it was a problem
before the procedure.”

Friedenberg and his colleagues published their findings in the August
issue of The American Journal of Gastroenterology.

Gastroesophageal reflux disease (GERD) occurs when a muscle at the end
of the esophagus does not close properly, allowing irritating stomach
contents to leak back into the esophagus. Symptoms include heartburn and
acid indigestion.

According to the new analysis, involving numerous studies, a high body
mass index (BMI) and/or high amounts of abdominal fat does appear to raise
the odds for significant acid reflux.

The researchers also found that diet-induced weight loss can help
minimize GERD symptoms.

However, not all weight-loss surgeries were equally beneficial with
respect to GERD, Freidenberg's team found.

Across several studies, a procedure known as Roux-en-Y gastric
bypass — which involves the creation of a small gastric pouch walled off
from (or bypassing) the rest of the stomach and intestinal track —
consistently appeared to help patients shed pounds and eliminate or
reduce GERD symptoms.

However, laparoscopic (gastric) banding was found to be less helpful in
tackling GERD.

The popular surgery, which involves the placement of a band to divide
and reduce the size of the stomach, initially debuted in 1993. It has
proven effective in helping patients feel satiated earlier, spurring
weight loss.

Patients often did lose weight after banding, the researchers found,
and this reduction in weight did not immediately encourage GERD. In fact,
in some cases, post-procedure weight loss appeared to moderately reduce
some reflux disease symptoms, the researchers said.

However, the inserted gastric band often seems to shift in place over
time, they said, leading to a reversal of any initial benefit and a
gradual worsening of GERD symptoms.

Based on these findings, Friedenberg and his team concluded that
gastric bypass may be “the preferred surgical technique” with specific
regard to GERD risk. But they also pointed out that more rigorous studies
need to be conducted to better understand the how's and why's of reflux
disease in the context of weight-loss surgery.

One expert said the current work highlights the need to carefully
assess the pros and cons of each weight-loss procedure.

“Gastric bypass is the most common and the most successful of the
surgical procedures to deal with obesity,” noted Dr. Anthony A. Starpoli,
an attending gastroenterologist at Lenox Hill Hospital and director of
gastro-esophageal research and endo-surgery at St. Vincent's Hospital,
both in New York City. “But the advantage to the banding procedure is
that, although it will not be an effective option for all patients —
depending on the level of obesity — it's a lot less aggressive than
bypass and has a lot less morbidity associated with it. And it's much more
reversible. So, there are reasons some patients might choose that
option.”

“However, that said, there is no ideal procedure,” Starpoli cautioned.
“Both bypass and banding are not without their set of complications. And
this study illustrates that while solving one problem, perhaps you worsen
another. So, I would say that if you're going into any of these procedures
to deal with obesity, and you have significant reflux, you definitely
first need to have an appropriate evaluation as if you were considering an
anti-reflux procedure.”

More information

There's more on GERD at U.S. National Institutes of Health.