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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Anders Thorell, Karolinska Institute, Stockholm, Sweden
- Second opponent: Professor Jan Gunnar Hatlebakk, University of Bergen
- Third member and chair of the evaluation committee: Associate Professor Christine Henriksen, University of Oslo
Chair of the Defence
Professor Mette Kalager, University of Oslo
Principal Supervisor
Birgitte Seip, Vestfold Hospital Trust
Summary
Impact of type 2 diabetes and bariatric surgery on gastroesophageal reflux disease and patient- reported outcomes.
Obesity and type 2 diabetes (T2D) are associated with increased risk of gastroesophageal reflux disease (GERD) which may cause serious health problems like esophagitis, ulcers, strictures, Barrett’s esophagus and esophageal adenocarcinoma. Roux-en-Y gastric bypass (RYGB) is considered an effective anti-reflux procedure, while sleeve gastrectomy (SG) may induce or worsen GERD.
The main objectives of this thesis were, first, to assess the impact of T2D on GERD and, second, to compare the effects of SG and RYGB on GERD and clinically important patient-reported outcomes in patients with severe obesity. We hypothesized that bariatric surgery candidates with T2D had a higher proportion of GERD than those without T2D, and that patients who underwent SG would have a higher 1-year risk of GERD and lower improvement in weight-related quality of life, remission of diabetes and weight loss. Symptoms were measured with validated questionnaires, and objective testing included esophagogastro-duodenoscopy, 24-hour pH monitoring and high-resolution manometry.
The results showed that the 1-year prevalence of symptomatic GERD did not differ significantly between groups with or without T2D (28% vs 18%), and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2D. SG was associated with a substantially higher 1-year risk of acid reflux and new-onset esophagitis than RYGB, but, irrespective of group, few patients reported GERD-symptoms.
At 3 years, RYGB was superior to SG regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about expected outcomes after the surgical procedures and may add knowledge to existing policies and guidelines.
Additional information
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