Optimization of the choice of bariatric surgery in a patient with heartburn and gastroesophageal reflux disease

Nowadays, there is no questions about the effectiveness of bariatric surgery for weight loss and improvement of the course of the metabolic syndrome. However, their influence on gastroesophageal reflux disease (GERD) and its main symptom - heartburn - remains discutable. Sleeve gastrectomy (SG) is one of the most frequently performed laparoscopic bariatric operations. It is considered that SG may lead to occurrence de novo or escalation of existing symptoms of reflux. But sometimes weight loss after bariatric surgery lead to decrease of such symptoms. In this regard, there is no consensus on whether it is worth considering the existing GERD as an absolute contraindication to the implementation of SG. The effect of gastric bypass (GBP) on the course of GERD seems to be more favorable. At the same time, cases of postoperative deterioration are also described in the literature. This article provides a review of the literature on the natural course and treatment of GERD, the impact of bariatric surgery on the disease, and proposes an algorithm for choosing a surgical intervention based on the review.