Avoiding Acid Reflux After Bariatric Surgery

Acid reflux is more than an uncomfortable condition that you have to live with. Instead, it is a testament to how our bodies function and whether we are on the right track. Before bariatric surgery, many patients have moderate to severe acid reflux because of the intra-abdominal pressure placed on their stomachs by excess visceral (belly) fat. This pressure forces stomach juices up through the lower esophageal sphincter and into the esophagus, often leading to the telltale burning sensation. Symptoms range from bad breath and yellow teeth to sore throats, dry cough, and even precancerous cellular development. These concerns become problematic with chronic acid reflux – a condition known as gastroesophageal reflux disease or GERD.

For many bariatric patients, especially those undergoing gastric bypass, gastroesophageal reflux disease or GERD is improved or eliminated after their surgical procedure. For some, however, especially patients with the gastric sleeve, there is a risk of new or worsened acid reflux due to the increased pressure within the newly formed and smaller gastric pouch. You may ask why this is the case with gastric sleeve and not gastric bypass. The gastric sleeve does not remove the stoma or valve separating the stomach from the small intestine. This strong seal can trap air, liquid, and food in the stomach, pushing it upward through the weaker lower esophageal sphincter.

Preventing Postoperative Acid Reflux

Unfortunately, the post-gastric sleeve acid reflux risk is real, but we can mitigate it. We have dramatically reduced its incidence by looking for and ultimately repairing a hiatal hernia, which is common in obese patients. A hiatal hernia occurs when the top of the stomach pushes through the hole in the diaphragm known as the hiatus and lodges itself next to the esophagus. This is generally painless but often causes reflux. A sliding hiatal hernia means the stomach moves in and out of the chest cavity without much resistance. A paraesophageal hiatal hernia, on the other hand, is more severe and means that the stomach is stuck next to the esophagus and will not fall back into the abdomen.

Of course, lifestyle change is also critical to avoiding acid reflux after bariatric surgery. Just because you’ve had bariatric surgery does not mean that you can liberalize all your habits. Smoking, alcohol consumption, drinking carbonated beverages, and eating spicy and acidic foods are all potential avenues to worsen reflux. Similarly, patients should continue following the advice that they should not eat within two hours of bed and keep their portions small. Sleeping propped up and/or on one’s left side are two helpful tactics to reduce reflux.

Treating reflux after bariatric surgery is usually straightforward. If patients do not get the relief they expect from antacids and Proton Pump Inhibitors PPIs, there is always the option of a revisional procedure, including a sleeve to bypass conversion or an endoscopic fix to help eliminate the reflux once and for all. If you are experiencing reflux after your bariatric procedure, speak to Dr. Higa about it. As you can imagine, we have worked with many patients to overcome this frustrating and often painful condition. Don’t go it alone. Use the resources around you to move beyond it.