Experiencing reflux post-bariatric surgery is a common concern, especially after having the going sleeve gastrectomy. Reflux is a condition characterized by the back flow of stomach acids into the esophagus, often causing discomfort. Patients may report sensations resembling choking or the ascent of liquid into their throat or mouth.
While the terms ‘reflux’ and ‘heartburn’ are commonly used interchangeably, they actually describe different conditions. Heartburn represents the sensation of burning, often felt in the chest or throat, particularly when lying down. It can result from various factors, including consuming spicy foods, overeating, or alcohol intake, and does not always indicate a medical problem. It’s possible to experience heartburn without reflux, or reflux without heartburn. Typical symptoms of reflux encompass a burning feeling in the chest (heartburn) or a sour or bitter taste in the mouth or throat due to acid backup (regurgitation).
Exploring the Causes of Reflux
The esophagus is a muscular tube leading to the stomach. The lower esophageal sphincter (LES), located at the esophagus’s lower end, is a muscle group that meets the stomach. The LES’s closure helps prevent stomach acids and contents from moving back up into the esophagus.
However, individuals with a weakened LES are more susceptible to reflux. Reflux can occur regardless of age, gender, or ethnicity, but the risk increases with factors like obesity, pregnancy, certain medications, or smoking habits.
Other Contributing Factors to Reflux
A hiatal hernia is another frequent contributor to reflux post-bariatric surgery. This occurs when part of the stomach pushes through the diaphragm’s hiatus, misplacing the stomach and potentially leading to reflux, chest discomfort, and vomiting.
Patients with morbid obesity are at heightened risk for hiatal hernias, often due to weakened diaphragm muscles that allow stomach protrusion. Increased intra-abdominal pressure is also a factor in overweight individuals. Additionally, weight gain post-bariatric surgery can lead to the development or recurrence of hiatal hernias, which then can cause reflux, chest pain, and sometimes vomiting.
Reflux Post-Bariatric Surgery
Around 35% of patients may develop reflux following a sleeve gastrectomy. This procedure creates a narrower, tighter stomach, increasing internal pressure after eating or drinking. The pylorus muscle, located at the stomach’s base and connecting it to the small intestines, plays a role here.
If the pylorus is too tight, combined with high pressure in the newly formed stomach pouch and a weakened LES, reflux can occur. To address reflux post-bariatric surgery, initial steps involve eliminating irritants like smoking, fatty or spicy foods, late-night eating, or alcohol consumption. Anti-reflux medication might also be prescribed.
Should these measures prove ineffective, surgical intervention may be suggested. For non-bariatric patients, this could involve tightening the esophageal sphincter. For those who have undergone weight loss surgery, a conversion to gastric bypass might be recommended, depending on the severity of symptoms. Reports indicate that 12 to 50% of sleeve-to-gastric bypass revisions occur due to reflux issues.
This conversion removes the pylorus muscle and forms a new passage between the pouch and the small intestines, facilitating smoother food passage and reducing acid back flow into the esophagus. However, it’s important to note that converting to gastric bypass, while effective, is not a guaranteed solution. Patients are advised to adhere to their surgeon’s guidelines and maintain regular appointments with their bariatric care team to manage and prevent reflux complications effectively