Evidence map›Paper›PMID 40877626›Full record

ArticleSurgical endoscopy2025

Mild to moderate GERD before sleeve: Can we better predict post-operative GERD?

Justine O Chinn, Perisa Ruhi-Williams, Mark Shacker, Micaela M Esquivel, Patricia Garcia, John O Clarke, Dan E Azagury

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Justine O ChinnDepartment of Surgery, Stanford University, 500 Pasteur Dr, Palo Alto, CA, 94305, USA. jchinn1@stanford.edu.ORCID http://orcid.org/0000-0002-6447-872X
Perisa Ruhi-WilliamsDepartment of Surgery, Stanford University, 500 Pasteur Dr, Palo Alto, CA, 94305, USA.
Mark ShackerCreighton University School of Medicine, Phoenix, AZ, USA.
Micaela M EsquivelDepartment of Surgery, Stanford University, 500 Pasteur Dr, Palo Alto, CA, 94305, USA.
Patricia GarciaDepartment of Gastroenterology, Stanford University, Stanford, CA, USA.
John O ClarkeDepartment of Gastroenterology, Stanford University, Stanford, CA, USA.
Dan E AzaguryDepartment of Surgery, Stanford University, 500 Pasteur Dr, Palo Alto, CA, 94305, USA.

Funding

AHRQ HHS T32
6 · The paper itself

Abstract

introductionGastroesophageal reflux disease (GERD) can be debilitating for patients after sleeve gastrectomy (SG). However, no clear numerical thresholds have been identified to help predict which patients will develop worsening symptoms post-operatively. We therefore sought to characterize which pre-operative wireless pH testing and endoscopy findings were associated with GERD after SG.

methodsPatients with a history of SG and pre-operative wireless pH studies were identified. Abnormal DeMeester score was defined as > 14.7 and abnormal acid exposure time (AET) as > 4% of time with a pH < 4. Clinically meaningful post-operative GERD was defined as GERD symptoms requiring proton pump inhibitor (PPI) therapy. We performed a univariate analysis and a Youden's index analysis to determine when DeMeester score and AET become predictive of post-operative GERD.

resultsOf 76 patients included, 41 patients (53.9%) reported pre-operative GERD symptoms. Of those with symptoms, 20% had LA Grade A or B esophagitis, 25% had a hiatal hernia, 56.1% had an elevated DeMeester score, and 58.5% had an elevated AET. Post-operatively, 13.2% (5/38) of patients with pre-operative symptoms required a PPI compared to 6.1% (p = 0.4) in patients without pre-operative symptoms. There was no difference in the rate of post-operative GERD between those with a normal vs abnormal pre-operative DeMeester (13.3% vs 13.0%, p > 0.9). In univariate analysis, abnormal DeMeester score (OR 1.25, p = 0.779), grade A or B esophagitis (OR = 1.70, p = 0.554), or abnormal AET (OR = 1.25, p = 0.779) were not predictive of post-operative GERD. However, a threshold of DeMeester score of ≥ 30 or AET ≥ 10.35 was predictive of post-operative GERD.

conclusionIn patients with moderate GERD, standard cutoffs of abnormal DeMeester score or AET were not predictive of post-operative GERD, however a threshold DeMeester score of ≥ 30 or AET ≥ 10.35 was predictive. Patients with such findings should be particularly counseled about the risk of post-operative GERD and/or offered a Roux-en-Y gastric bypass.

Indexed as

GastrectomyGastroesophageal RefluxObesity, MorbidPostoperative ComplicationsAdultEsophageal pH MonitoringFemaleHumansMaleMiddle AgedPredictive Value of TestsProton Pump InhibitorsRetrospective StudiesSeverity of Illness IndexProton Pump InhibitorsBariatric surgeryGastro-esophageal refluxGERDpH studySleeve gastrectomy

Identifiers

PMID40877626

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