Bariatric Surgery Linked too Higher Esophageal Complication Risk Than GLP-1 Medications, Study Finds
PHOENIX – A large, propensity-matched study presented at teh American College of Gastroenterology 2025 Annual Scientific Meeting indicates that bariatric surgery, especially sleeve gastrectomy, is associated with a significantly increased risk of esophageal complications compared to treatment with glucagon-like peptide-1 receptor agonists (GLP-1 ras) for weight loss.
Researchers led by Himsikhar Khataniar, MD, from Allegheny General Hospital in Pittsburgh, PA, analyzed data from the TriNetX U.S. Collaborative Network, examining outcomes in individuals with a body mass index of 30 kg/m² or higher. The study compared those who initiated FDA-approved weight-loss GLP-1 RA therapy (liraglutide, semaglutide, or tirzepatide – grouped together for analysis) with those who underwent sleeve gastrectomy or Roux-en-Y gastric bypass between 2015 and 2020.
The analysis excluded individuals with prior GLP-1 RA exposure, previous bariatric surgery, or a history of GERD, esophagitis, Barrett esophagus, esophageal cancer, scleroderma, pregnancy, or intensive-care admission. Propensity-score matching was used to balance 47 demographic,clinical,medication,and laboratory variables between the groups.
The study included 89,422 bariatric surgery recipients (mean age 49 years; 73% female) and 84,689 GLP-1 RA users (mean age 53 years; 56% female) before matching. Following matching, both cohorts had a mean age of 51 years and were 65% female.
Researchers assessed the incidence of de novo reflux esophagitis, GERD, Barrett esophagus, esophageal cancer, esophagogastroduodenoscopy (EGD) utilization, and initiation of acid-suppression therapy.
Results showed that reflux esophagitis occurred in 0.7% of surgery patients versus 0.4% of GLP-1 RA users – nearly double the risk with surgery. GERD developed in 16.9% of surgery patients compared with 9.8% of GLP-1 RA users, representing an 88% increased risk with surgical intervention. Barrett esophagus was also more common after surgery, occurring in 0.5% of patients versus 0.2% of GLP-1 RA users – double the risk. Esophageal cancer rates were rare and did not differ significantly between groups.
EGD utilization was substantially higher in the surgery group (8.8%) compared to the GLP-1 RA group (3.7%). Similarly, initiation of proton-pump inhibitors occurred in 29.4% of surgery patients versus 20.8% of GLP-1 RA users, and H-receptor antagonist prescriptions were needed in 15.6% of surgery patients versus 11% of GLP-1 RA users.
Notably, tirzepatide users exhibited the lowest GERD incidence at 6.4%, while sleeve gastrectomy had the highest rate at 19.1% relative to other GLP-1 RAs.
The researchers reported no relevant financial relationships.
