**2.8 Gastroesophageal reflux disease (GERD)**

LSG may improve GERD symptoms as a result of the accelerated gastric emptying and WL. A study of GERD in 65 patients after LSG, including 24-hour pH probe data, suggested that the preexisting reflux improved, and that the de novo reflux rate was low (5.4%) [31]. Appraisal of LSG's effects of on GERD (median follow-up 56 months) using a quality-of-life questionnaire found that GERD-HRQL scores decreased from 7 to 3 [32]. In the same study, GERD-HRQL scores improved in 55 patients, worsened in 21, de novo GERD was observed in 10, and no change in 14 patients [32]. A systematic review (25 studies) reported clinical improvement in 1863 patients at an average of 20 ± 15 months post-LSG; however the review also reported worsening of symptoms in 5953 patients over a period of 29 ± 22 months [33]. However, most research used clinical evaluation, with few studies using endoscopy, 24-hour ambulatory pH, esophageal manometry or contrast studies [33].
