Bariatric surgery is a form of weight loss surgery. Gastroesophageal reflux disease (GERD) is a condition that causes food to re-enter a person’s esophagus from their stomach. Although bariatric surgery can help to reduce GERD symptoms, it can occasionally cause them to develop.
Bariatric surgeries treat obesity and its related conditions. Surgeons perform this procedure on parts of the digestive system.
GERD is a condition that can cause frequent backflow of a person’s stomach contents. This can cause symptoms such as heartburn or acid reflux. Acid reflux occurs when stomach acid travels back up a person’s esophagus. Acid reflux can cause a burning sensation in the throat or chest or a bitter taste in a person’s mouth.
Certain bariatric surgeries
Read on to learn more about GERD and bariatric surgeries, as well as treatments and possible complications.
Bariatric surgeries may change the shape of a person’s stomach or reroute how food travels through the intestines. These changes can affect the lower esophageal sphincter (LES).
The LES is a ring of muscle at the base of a person’s esophagus. The LES opens to allow food into the stomach then closes to prevent substances from re-entering the esophagus.
If the LES stops working correctly, it may allow stomach contents to travel into the esophagus. This can lead to GERD symptoms and acid reflux.
Bariatric surgeries can affect the LES
- flattening of the angle where the esophagus meets the stomach, which some may refer to as the “angle of His,” meaning stomach contents can re-enter the esophagus more easily
- increased pressure inside the stomach, which may put pressure on the LES, causing it to reopen
- food staying inside the stomach for longer
- reduced LES pressure, which can make it unable to close the esophagus properly
- hiatal hernias developing after surgery, which occur when part of the stomach bulges into a person’s chest through their diaphragm
Researchers have found that certain bariatric surgeries can improve GERD symptoms. However, some forms of bariatric surgery can worsen GERD symptoms or cause them to develop.
Roux-en-Y gastric bypass (RYGB)
RYGB surgery is one of the most common forms of bariatric surgery. During RYGB surgery, surgeons separate the stomach into two sections. One of these sections is around the size of an egg, while the other is larger.
The surgical team connects a small portion of the stomach directly to part of the small intestine and attaches the larger part of the stomach to a different part of the small intestine. Gastric juices from the larger stomach section can then mix with ingested food in the small intestine.
According to researchers, an RYGB is the
A 2020 review found that 9 months after RYGB surgery, 94% of people studied had improvement in GERD symptoms. Additionally, the number of people taking medication for GERD reduced from 30% to 5% after RYGB surgery.
A sleeve gastrectomy involves a surgeon removing around 80% of a person’s stomach. This smaller stomach holds less food. Additionally, this reduces the amount of hunger-causing hormones.
Research suggests that sleeve gastrectomies can actually increase GERD symptoms. The same 2020 review mentioned above noted that 84.1% of people who had GERD still had it after sleeve gastrectomy surgery. Additionally, 44% of people had an increase in acid reflux 18 months after sleeve gastrectomy surgery.
A study from 2021 found that up to 40% of people who had a sleeve gastrectomy developed GERD after surgery.
Sleeve gastrectomies may affect GERD symptoms, as they can alter the angle of His. Additionally, sleeve gastrectomies can increase pressure inside the stomach, which can disrupt LES function.
Adjustable gastric band (AGB)
An AGB is an adjustable silicone band that surgeons place around the top of a person’s stomach. This creates a smaller gastric pouch, which helps to reduce the amount of food a person can eat.
Research shows mixed results regarding AGB and GERD. A
The researchers also looked into the difference between people who had GERD following ABG and those who did not. They found that those with GERD symptoms had significantly larger gastric pouches.
They also found that some people who had AGB surgery developed GERD years after the procedure. The review found that
Researchers theorize that band placement in AGB surgery may cause increases in pressure, leading to GERD symptoms.
There are various ways a person can treat acid reflux or GERD after bariatric surgery. Treatments can include:
Proton pump inhibitors (PPIs) are generally the first treatment doctors prescribe for GERD or acid reflux symptoms. These medications help to reduce the production of acid in a person’s stomach.
Prokinetic agents can also treat GERD symptoms. These drugs help to strengthen LES contractions, as well as muscle contractions along the gastrointestinal (GI) tract.
If medication does not successfully treat GERD or acid reflux symptoms, a person may require surgery.
Different surgeries can treat GERD or acid reflux that develops following bariatric surgery. These surgeries include:
RYGB surgery can treat GERD or acid reflux that develops following other bariatric surgeries. Conversion from AGB and sleeve gastrectomy procedures to an RYGB has proved safe and successful.
If a person develops GERD after an RYGB, a surgeon may reduce the size of their gastric pouch. A surgeon can also lengthen the amount of small intestine attached to the gastric pouch.
LINX surgery involves a surgeon implanting a ring of magnets around the base of a person’s esophagus. This ring helps to close the esophagus after eating, reducing reflux symptoms.
The Stretta procedure can strengthen a person’s LES without surgery. During the Stretta procedure, doctors inserted a device into a person’s throat. This device emits low heat radiofrequency, which helps to thicken and strengthen the LES muscle.
It is important that a person receives treatment if they have GERD or acid reflux after bariatric surgery. Untreated GERD can lead to the development of serious conditions, such as:
- erosive esophagitis, which is severe inflammation of the esophagus due to acid exposure
- peptic strictures, a narrowing of the esophagus that leads to trouble swallowing
- Barrett’s Esophagus, a condition that causes the esophagus lining to change and resemble intestinal lining
- esophageal cancer
If a person notices their GERD or acid reflux symptoms persist after bariatric surgery, they should speak to their doctor.
GERD symptoms and acid reflux may develop following certain bariatric surgeries. However, RYGB procedures can help improve GERD and acid reflux symptoms.
There are various treatments available for a person who has GERD following bariatric surgery. These include medications or surgery.
If a person develops GERD or notices GERD symptoms increasing after bariatric surgery, they should speak with their doctor. Left untreated, GERD and acid reflux can cause serious conditions to develop.