Gastroesophageal Reflux and Gastrointestinal Symptoms After Metabolic and Bariatric Surgery in Adolescents: An 8-year Follow-up Analysis

J Pediatr Surg. 2025 Apr;60(4):162215. doi: 10.1016/j.jpedsurg.2025.162215. Epub 2025 Jan 31.

Abstract

Importance: Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed metabolic and bariatric surgery (MBS) procedures in adolescents and adults. Despite their safety and effectiveness, there is concern over postoperative gastrointestinal symptoms (GIS), especially gastroesophageal reflux symptoms (GERS), in those undergoing VSG.

Objective: To evaluate the long-term prevalence of GIS in adolescents who underwent RYGB or VSG.

Design, setting, and participants: This is a prospective, multicenter, observational cohort study at five academic referral centers in the United States. Patients were enrolled from February 28, 2007, through December 30, 2011. The analysis included 228 adolescents: 161 RYGB and 67 VSG followed prospectively for 8 years.

Main outcomes and measures: Patient-reported GIS before surgery and across 8 years of postoperative follow-up were assessed. We dichotomized postoperative symptom severity and analyzed the data using general linear mixed models.

Results: Adolescents undergoing either VSG or RYGB demonstrated significant increases in abdominal pain (10 % vs. 17 %), bloating (8 % vs. 20 %), and constipation (3 % vs. 9 %) between baseline and 8 years (p < 0.05). Following RYGB, the prevalence of GERS was not statistically significantly different between baseline (12 %) and 8 years (13 %) (p > 0.05). Following VSG, however, GERS increased from 9 % preoperatively to 27 % at 8 years (p < 0.05). In adjusted analyses, VSG was associated with higher odds of GERS at 8 years (adjusted odds ratio 2.67 [1.57-4.55, 95%CI]).

Conclusions and relevance: GERS represents a considerable concern pre- and post-MBS in adolescents, especially after VSG. Appropriate patient selection along with counseling and objective monitoring for pathologic consequences of gastroesophageal reflux after MBS are warranted.

Trial registration: Clinicaltrials. gov Identifier: NCT00474318.

Type of study: Prospective, multicenter, observational cohort.

Level of evidence: Level II.

Keywords: GERD; GERS; Gastrointestinal symptoms; Long-term outcomes; Metabolic and bariatric surgery; Obesity; Reflux.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Abdominal Pain / epidemiology
  • Abdominal Pain / etiology
  • Adolescent
  • Bariatric Surgery* / adverse effects
  • Constipation / epidemiology
  • Constipation / etiology
  • Female
  • Follow-Up Studies
  • Gastrectomy* / adverse effects
  • Gastrectomy* / methods
  • Gastric Bypass* / adverse effects
  • Gastroesophageal Reflux* / epidemiology
  • Gastroesophageal Reflux* / etiology
  • Humans
  • Male
  • Obesity, Morbid* / surgery
  • Pediatric Obesity* / surgery
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Prevalence
  • Prospective Studies
  • United States / epidemiology

Associated data

  • ClinicalTrials.gov/NCT00474318