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Fontan et al . Mini-invasive Surg 2020;4:29 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.09

Review Open Access

Current management of gastroesophageal reflux
disease in the obese population - a review of the
literature

Fermin M. Fontan , Rory S. Carroll , Dakota Thompson, Ryan K. Lehmann, Jessica K. Smith, Peter N.
#
#
Nau
University of Iowa Hospital and Clinics, Department of Minimally Invasive, Bariatric and Gastrointestinal Surgery, Iowa City,
IA 52242-1086, USA.
# Co-equal first authors.

Correspondence to: Dr. Peter N. Nau, Roy J. and Lucille A. Carver College of Medicine, Department of Minimally Invasive,
Bariatric and Gastrointestinal Surgery - 200 Hawkins Drive, 4634 JCP Iowa City, IA 52242-1086, USA.
E-mail: peter-nau@uioea.edu

How to cite this article: Fontan FM, Carroll RS, Thompson D, Lehmann RK, Smith JK, Nau PN. Current management of
gastroesophageal reflux disease in the obese population - a review of the literature. Mini-invasive Surg 2020;4:29.
http://dx.doi.org/10.20517/2574-1225.2020.09

Received: 13 Jan 2020 First Decision: 2 Mar 2020 Revised: 17 Mar 2020 Accepted: 22 Apr 2020 Published: 16 May 2020
Science Editor: Wah Yang Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
The current obesity pandemic has a clear impact on quality of life and health resource utilization; hence it has
become a significant global health concern. Multiple obesity-related comorbidities such as gastroesophageal reflux
disease (GERD) are frequently observed among this patient population. GERD is a complex disease with multiple
elements contributing to the failure of the anti-reflux barrier. If left untreated, the excessive reflux of gastric
contents into the esophagus can give rise to multiple complications such as esophagitis, strictures, metaplasia,
and cancer. When surgical treatment of GERD is indicated in an obese patient, adequate preoperative evaluation
and treatment are critical to achieve durable resolution of symptoms attributed to GERD as well as other obesity
related comorbidities. To maximize the potential for a positive outcome, when suitable, gastric bypass surgery
rather than sleeve gastrectomy or fundoplication should be strongly considered in the obese patient with GERD.

Keywords: GERD, gastroesophageal reflux disease, bariatric surgery, RYGB, Roux-en-Y gastric bypass, SG, sleeve
gastrectomy, fundoplication, BE, Barrett’s esophagus

INTRODUCTION
The obesity pandemic has become a significant global health problem. Since 1975, the world prevalence
2
of obesity has nearly tripled, and at least 650 million adults currently have a BMI greater than 30 kg/m .
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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