The Impact of Gastroparesis on Surgical Therapy for Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) and gastroparesis frequently present together. This concurrence represents both a diagnostic and surgical management challenge. There is controversy regarding the etiological relationship between these conditions, which extends into controversy on the proper surgical management of concurrence. Patients with gastroparesis and medically refractory GERD are often referred for consideration of antireflux surgery (ARS), but there is disagreement as to whether gastroparesis impacts surgical outcome. This review critically evaluates data concerning whether gastroparesis affects reflux control, the impact of ARS on gastroparesis symptoms and gas-bloat syndrome, physiologic changes in gastric emptying after ARS, and the role of pyloric drainage surgery in the patient undergoing ARS. Many of the studies on these topics are limited in sample size and not designed to specifically determine the impact of gastroparesis on ARS outcomes. Consequently, the available data is heterogeneous, and studies draw conflicting conclusions. Based on this controversial and limited literature, clinical reasoning, and anecdotal experience, we discuss surgical management of concurrent GERD and gastroparesis.