What’s the Link Between Acid Reflux and Gastric Bypass?

What’s the Link Between Acid Reflux and Gastric Bypass?

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Gastric bypass is a popular weight loss procedure done by bariatric surgeons to treat obesity. It has another name, Roux-en-Y gastric bypass (RYGB), a bariatric procedure that alters (re-routes) the digestive system. In this procedure, the bariatric surgeon separates the stomach into two sections, a small pouch (roughly the size of an egg) in the upper part and a large one. Both sections are separated by stapling, and the small pouch is connected to a part of the small intestine. Following the procedure, food consumption will be reduced, which eventually reduces calorie absorption.

Gastro–oesophageal reflux disease (GERD) is a chronic digestive disorder. In this condition, the stomach contents (food), including acid, might enter back into the esophagus (food pipe) from the stomach. This backflow is referred to as acid reflux, which can damage the esophageal lining, resulting in various symptoms like heartburn.

Most bariatric surgeries reduce GERD or acid reflux symptoms; unfortunately, in rare cases, certain bariatric procedures can cause them to develop as a side effect.

What’s the Link Between Acid Reflux and Gastric Bypass?

Most of the bariatric surgeries involve altering the stomach shape and the digestive process. These changes might affect a ring of muscle called the lower esophageal sphincter (LES), which is located at the bottom of the oesophagus. The LES plays a unique role: it opens the sphincter, allowing the consumed food to enter the stomach, and then closes it to stop the food and other stomach contents from flowing back into the esophagus.

If the LES fails to work properly, the stomach contents might travel back into the food pipe, which leads to conditions like GERD and acid reflux.

LES is affected by bariatric surgeries due to:

• “angle of His”—it is referred to as the angle where the esophagus and the stomach meet. After surgery, this angle might become flat, allowing the contents from the stomach to enter the food pipe more effortlessly.
• pressure increased inside the stomach might exert pressure on the LES ring, forcing it to reopen
• allowing the food to stay inside the stomach for more time
• fail to close the LES ring due to reduced pressure
• hiatal hernias—a condition in which a part of the stomach protrudes through the diaphragm into the chest; usually develops following surgery 

As previously stated, not all bariatric procedures are successful at treating acid reflux. However, experts say RYGB is the most effective procedure to provide relief from GERD symptoms. This is because in the RYGB surgical procedure, the route of food and acid is altered, reducing the possibilities of backflow. 

RYGB not only aids in weight loss but also reduces the production of stomach acid. In addition, weight loss can relieve stomach pressure, which helps in reducing GERD symptoms.

A review from 2020 suggests that, after nine months of RYGB surgery, around 94% of people had slight relief from GERD symptoms. Also, the percentage of people who are taking GERD medication decreased from 30% to 5% following RYGB surgery.

In the same review, they stated that 84.1% of people who underwent sleeve gastrectomy have not seen any improvement in their GERD condition. Moreover, the GERD symptoms aggravated after 18 months post-surgery. 

Obesity and acid reflux

Being obese is a common risk factor for GERD or acid reflux. This is because the excess fat built up in the abdominal area puts pressure on the stomach, which makes it easier for acid to flow back into the food pipe (esophagus). So, weight loss is one of the best solutions to reduce this intra-abdominal pressure and relieve GERD symptoms.

Treatment for acid reflux or GERD following bariatric surgery

Various treatment options are available to treat gastro–oesophageal reflux disease, or acid reflux, that occurs after bariatric surgery. Initially, doctors recommend usage of medications that include proton pump inhibitors (PPIs) or prokinetic agents. PPIs help to reduce the production of acid in the stomach. Prokinetic agents are the drugs that strengthen LES contractions and other muscles along the GI tract.

If medication fails to treat GERD or acid reflux symptoms, surgery is the next best option.

• If GERD symptoms develop after any bariatric surgery, doctors prefer converting them to RYGB because it is proven to be safe and successful. 
• What if GERD  develops after the RYGB procedure? The surgeon might reduce the pouch size or lengthen the small intestine that is connected to the gastric pouch.
• The LINX reflux management system is a minimally invasive surgical procedure that reduces reflux symptoms by closing the esophagus after eating. In this procedure, the surgeon implants a ring of magnetic beads around the lower esophageal sphincter (LES) to control the closing function.
• The Stretta is a minimally invasive endoscopic procedure to strengthen the LES ring. The procedure involves inserting a device into the throat that emits low-heat radiofrequency waves, which makes the LES muscle thick and strong. 

Treatment for GERD or acid reflux following bariatric surgery is necessary because untreated GERD conditions might lead to severe health conditions. If you are obese and having GERD problems, consult an expert bariatric surgeon. Consult Dr. Venuopal Pareek, one of the best laparoscopic and bariatric surgeons in Hyderabad, an expert in treating GERD or acid reflux problems post-bariatric surgery. Take the first step towards your health; schedule your consultation with the doctor now: ‪+91 91777 77715.