Gastroesophageal reflux and gastrointestinal symptoms after metabolic and bariatric surgery in adolescents: an 8-year follow-up analysis

Authors: RODE, JOHN - Ann And Robert H Lurie Children'S Hospital Of Chicago; ZEINEDDIN, SUHAIL - Ann And Robert H Lurie Children'S Hospital Of Chicago; KHOURY, JANE - Children'S Hospital - Cincinnati, Ohio; JENKINS, TODD - Children'S Hospital - Cincinnati, Ohio; SISLEY, STEPHANIE - Baylor College Of Medicine; COURCOULAS, ANITA - University Of Pittsburgh School Of Medicine; RYDER, JUSTIN - Ann And Robert H Lurie Children'S Hospital Of Chicago; MICHALSKY, MARC - Nationwide Children'S Hospital; INGE, THOMAS - Ann And Robert H Lurie Children'S Hospital Of Chicago

Submitted to: Journal of Pediatric Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/24/2025
Publication Date: 4/20/2025
Citation: Rode, J.B., Zeineddin, S.A., Khoury, J.C., Jenkins, T.M., Sisley, S.R., Courcoulas, A.P., Ryder, J.R., Michalsky, M.P., Inge, T.H. 2025. Gastroesophageal reflux and gastrointestinal symptoms after metabolic and bariatric surgery in adolescents: an 8-year follow-up analysis. Journal of Pediatric Surgery. 60(4). Article 162215. https://doi.org/10.1016/j.jpedsurg.2025.162215.
DOI: https://doi.org/10.1016/j.jpedsurg.2025.162215

Interpretive Summary: Two common types of weight-loss surgery for teens are called vertical sleeve gastrectomy (VSG) and roux-en-Y gastric bypass (RYGB). Both can help with weight and health, but some teens have stomach problems afterward, like heartburn or belly pain. This study followed 228 teens for 8 years after surgery to see how often these problems happened. Both groups had more belly pain, bloating, and constipation over time. For teens who had RYGB, heartburn (also called gastroesophageal reflux) didn’t really change. However, for those who had VSG, heartburn became much more common—going from 9% before surgery to 27% eight years later. This shows that VSG might lead to more heartburn problems. More research is needed to determine if there are long-term health consequences to increased heartburn in adolescents undergoing weight loss surgery with VSG.

Technical Abstract: 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. To evaluate the long-term prevalence of GIS in adolescents who underwent RYGB or VSG. 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. 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. 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]). 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.