Gastroesophageal Reflux Disease, reflux after weight loss surgery
Post Weight Loss Surgery
Causes of Reflux after Weight Loss Surgery

Acid reflux after weight loss surgery is a relatively common side effect, particularly after the sleeve gastrectomy. Acid reflux is characterized as the backflow of stomach contents into the esophagus. In many cases, patients will feel like they are choking or have a liquid coming up into their throat or mouth. 

Although we often hear the terms reflux and heartburn used interchangeably, they refer to different things. Heartburn is the actual feeling of acid reflux; the burning sensation a patient may feel in their upper to mid-chest or throat, particularly when lying down. Heartburn can be caused by eating spicy foods, overeating, or drinking alcohol, and thus isn't always caused by an underlying medical condition. Patients can have heartburn without reflux, and they can have reflux without heartburn. 

Common reflux symptoms include a burning sensation in the chest (heartburn) or a sour, bitter-tasting acid backing up into the throat or mouth (regurgitation). 

Causes of Reflux

The esophagus is a long, muscular tube. At the bottom of the esophagus is the lower esophageal sphincter (LES), a bundle of muscles that meet the stomach. When the LES is closed, it prevents acid and stomach contents from traveling back into the esophagus. 

Unfortunately, some individuals have a weak lower esophageal sphincter, allowing stomach contents to reflux back up more easily. Nonetheless, anyone can develop reflux regardless of age, sex, or ethnicity. But you are more likely to experience reflux if you are overweight, pregnant, take certain medications, or smoke. 

Other Causes of Reflux

Another more common cause of reflux is the prevalence of a hiatal hernia. A hiatal hernia occurs when part of the stomach slides into the chest through a hole in the diaphragm called the hiatus. When this happens, it places the stomach in an unnatural position, causing various problems, from reflux to chest pain and vomiting. 

Morbidly obese patients are at a higher risk of developing a hiatal hernia. Hiatal hernia development is due to weakened muscle tissue that allows the stomach to bulge through your diaphragm. Patients who are overweight experience an increase in intra-abdominal pressure. 

Similarly, patients who experience weight regain after bariatric surgery can have the recurrence or even initial development of a hiatal hernia. And the development of a hiatal hernia after bariatric surgery will act the same way—causing reflux, chest pain, and in some cases, vomiting.

Why Reflux after Weight Loss Surgery Occurs

reported 35% of patients will develop reflux after a sleeve gastrectomy. The sleeve gastrectomy is a bariatric operation that creates a very narrow, tight stomach, ultimately causing pressure inside the new pouch after eating or drinking. At the bottom of the stomach is a muscle called the pylorus, which connects the stomach to the small intestines. 

If the pylorus muscle is too tight and there is too much pressure in the new pouch, patients can experience reflux, particularly if they have a weakened lower esophageal sphincter. 

“Some reports suggest that 12 to 50% of patients who had their sleeve revised to a gastric bypass did so due to reflux complications. ”

How to Treat Reflux after Weight Loss Surgery

If a patient is experiencing reflux after weight loss surgery, we will initially propose that they eliminate any irritants such as smoking, eating fatty or spicy foods, eating late at night, or drinking alcohol. We may also prescribe an anti-reflux medication as needed. 

However, if this does not fix the reflux, we may recommend surgery. For a patient who has not had bariatric surgery, we may be able to surgically correct this condition by tightening the muscle at the bottom of the esophagus (sphincter) so that stomach contents are less likely to slide up.

For individuals who have had weight loss surgery, we may recommend a revision to a gastric bypass, depending on your reflux symptoms and severity. Some reports suggest that 12 to 50% of patients who had their sleeve revised to a gastric bypass did so due to reflux complications. 

When we convert the gastric sleeve to the gastric bypass, we remove the pylorus muscle (the muscle at the bottom of the stomach) and create a man-made connection between the pouch and the small intestines. This new connection allows food and other stomach contents to flow more freely and lowers the chances of stomach contents flowing back into the esophagus. 

Yet, although a revision to a gastric bypass is a good anti-reflux treatment, it is not a 100% cure. We recommend patients follow their surgeon’s guidelines and attend their regular follow-up appointments with their bariatric care team to prevent further implications of reflux. 

Charles Procter, MD
Dr. Charles Procter is at the heart of what Beltline Health has to offer, providing caring, compassionate, and expert resources to those hoping to lose weight and live a happier, healthier life. Dr. Procter is an expert in minimally-invasive techniques and robotic-assisted surgery practices. In 2008, he became the first surgeon in Georgia to perform a robotic-assisted cholecystectomy. He later performed the first fully robotic bariatric procedures, including sleeve gastrectomy, Roux-en Y gastric bypass, and duodenal switch surgeries. Dr. Procter has over a decade of experience in bariatric surgery and general surgery and is the founding member of the Beltline Health family starting the practice in 2016.
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