Khadije Momeni,1,*Rozhan Riahi,2Sarah Marzoughi,3Ziba Zamani,4Fateme Dihghannayeri,5
1. Department of Operating Room school of Allied Medical Sciences Bushehr University of Medical Sciences, Bushehr, Iran 2. Student Research Committee, Dr. Shahinfar Medical Faculty-Islamic Azad University Of Mashhad, Mashhad, Iran 3. Student Research Committee, Dr. Shahinfar Medical Faculty-Islamic Azad University Of Mashhad, Mashhad, Iran 4. Student Research Committee, Dr. Shahinfar Medical Faculty-Islamic Azad University Of Mashhad, Mashhad, Iran 5. Student Research Committee, Dr. Shahinfar Medical Faculty-Islamic Azad University Of Mashhad, Mashhad, Iran
Introduction: Laryngeal reflux disease (LPRD) refers to the return of contents from the stomach to the larynx.
A person with LPRD usually has symptoms such as throat clearing, hoarseness, excessive mucus production, chronic cough, and globus pharyngeus.
Bariatric surgery provides effective management of obesity and obesity-related diseases. This "metabolism-changing" surgery is not without complications. However, gastroesophageal reflux disease (GERD) is the most common complication. Gastric bypass (GB) and sleeve gastrectomy (SG) are common bariatric surgery methods. According to the findings, bariatric surgery, especially SG, can lead to new onset of GERD in many patients, meanwhile, LPR symptoms in GERD patients can be up to 40%, excluding silent reflux.
Methods: In the upcoming review article, data were collected using keywords and using valid databases such as PubMed, Google Scholar, Scopus and ProQuest. In this study, our statistical population includes all the articles that have been published until 2022.
Results: RSI and RFS were adopted to evaluate and investigate LPR among obese patients, as we realized the importance of symptomatic definition of LPR rather than pH-based assessment.
The difference in RSI and RFS examination trends shows the complexity of LPR diagnosis. Therefore, the assessment of LPR using one method may be inaccurate. For this reason, it is very appropriate to use RSI and RFS as a combined tool to evaluate LPR in obese patients.
The findings also showed that several patients who were well before surgery had a new onset of LPR endolaryngeal symptoms after surgery. Therefore, bariatric surgeons should discuss the risk of de novo LPR with bariatric surgery candidates. Patients who develop de novo LPR may also be started on appropriate therapy, such as proton pump inhibitors, to minimize the effects of reflux. In the presence of non-specific symptoms of the larynx, it is very necessary to examine endolaryngeal evaluations before and after surgery in candidates for bariatric surgery.
We believe that the improved reflux profile among GB patients is due to the following factors:
1. The presence of rare parietal cells in the lesser curvature of the newly formed gastric pouch reduces the exposure of acid to the hypopharynx.
2. Because the small intestine is valveless, a gastrojejunostomy creates a low-pressure luminal system.
3. In GB, gastrojejunostomy and a long loop help reduce subsphincteric pressure (compared to SG) because it bypasses the action of the strong pyloric sphincter mechanism.
Therefore, GB may be the method of choice in obesity-related LPR compared to SG.
Conclusion: Obesity is a global health epidemic with considerable economic burden.
GB has a better LPR endolaryngeal profile in postsurgery patients. We believe that a thorough evaluation of reflux symptoms as well as esophageal anatomy and pathology should be systematically undertaken in all patients considered for bariatric surgery. This should be followed by an informed and open discussion with the patient about risks and benefits of different bariatric surgical options, leading to optimal shared decision-making.