Concordant and Discordant Interrelationships of the GERD Triad of Symptoms, Endoscopy Findings, and Histopathological Changes Over Time after One Anastomosis Gastric Bypass

Background: Reflux-related symptoms, upper endoscopy (UE), and histopathology findings comprise a triad of changes of gastro-esophageal reflux disease (GERD) following one anastomosis gastric bypass (OAGB). However, the evolution and interplay between these changes across time have not been sufficiently evaluated. Methods: This study is a retrospective analysis of the GERD triad in 150 patients using GerdQ questionnaire, UE, and histopathology at year 1 and year 3 after OAGB. Evolution of the GERD triad was explored, covering five areas: evolution of changes in the GERD triad over time; relationships and correlations between changes in the GERD triad components in the form of concordance or discordance among these components; subsets of patient demographics or time intervals that necessitate heightened awareness for post-OAGB reflux-related abnormalities; characteristics defining concordant compared to discordant cases; and potential predictors that increase the likelihood of discordance. Setting: University hospital, Alexandria, Egypt. Results: Mean age was 34.7 years, with 75.3% females. At year 1, 25.7% were symptomatic, yet 62.5% and 65.3% of patients had UE and histopathology abnormalities respectively. Hence, 36.8% of patients with abnormal UE and 39.6% with abnormal histopathology were asymptomatic. At year 3, 55.6% were symptomatic, yet 75.8% and 78.2% had UE and histopathological abnormalities respectively. Discordant cases comprised 39.6% and 22.6% of patients at years 1 and 3 respectively. There were no significant differences in patient characteristics between concordant and discordant cases at years 1 and 3. Although symptoms were significantly one-third lower at year 1 compared to year 3, the likelihood of discordance was significantly higher at year 1 (OR = 2.81, 95% CI = 1.64–4.80, p < 0.001) and in patients with elevated hemoglobin (OR = 1.37, 95% CI = 1.10–1.71, p = 0.005). Conclusion: There was variable evolution of the GERD triad. Concordant cases posed no significant clinical threats, while discordant cases require a high index of suspicion. At year 1, there were more asymptomatic patients with more discordance, while the higher likelihood of symptoms at year 3 calls for extended follow up beyond year 3.