Considerations in the management of gastroesophageal reflux disease in the morbidly obese

Gastroesophageal reflux disease (GERD) is a common problem both within the United States and worldwide. The incidence in the USA has been estimated to be nearly 30%. The estimated cost of treating GERD and GERD symptoms in the USA has been estimated to be upwards of $60 billion. GERD related symptoms in the obese and morbidly obese population have been demonstrated to be consistently higher than those in the non-obese population. There are papers quoting the incidence to be up to 50% in those with a BMI greater than 30 kg/m 2 . There are also many publications demonstrating a positive correlation of increased BMI and related symptoms or reflux demonstrated on pH monitoring. Roux-en-Y Gastric Bypass (RYGB) has been shown to be an effective procedure at controlling symptoms in the patient with GERD as well as reverse some of the negative health effects it can cause. Given that GERD is such an issue for these patient and bypass can provide proven relief, it is one of the few conditions that qualifies patient for bariatric surgery at a BMI cut off of 25 kg/m 2 . The high incidence and prevalence of GERD related symptoms within the obese and morbidly obese populations is a common problem encountered in a general or bariatric surgeon’s practice. We seek to provide a brief review and common treatment pathways to deal with GERD in the obese population.