Post-gastric bypass surgery complications and potential issues related to GERD (Gastroesophageal reflux disease)
Bariatric surgeries, designed to treat obesity and related conditions, can have varying effects on Gastroesophageal Reflux Disease (GERD) and acid reflux symptoms.
Roux-en-Y Gastric Bypass (RYGB)
This common form of bariatric surgery typically improves or resolves GERD symptoms. RYGB separates the stomach into two sections and connects them to different parts of the small intestine, reducing acid reflux by limiting acid exposure in the esophagus. Many patients experience relief or remission of GERD after RYGB [1][3][4].
Sleeve Gastrectomy (SG)
While SG can help with weight loss, it can sometimes worsen or even cause new GERD symptoms postoperatively. This is due to the surgery reducing stomach volume but not bypassing the acid-producing part, which may increase acid reflux [3][5]. In such cases, conversion to RYGB may be considered as a revision procedure to improve reflux symptoms effectively.
One-Anastomosis Gastric Bypass (OAGB)
OAGB has outcomes similar to RYGB in terms of weight loss and resolution of comorbidities, but it may have a higher risk of biliary reflux, which can mimic or exacerbate reflux symptoms and sometimes requires revision surgery [1].
Weight loss itself, regardless of surgery type, often leads to improvement in GERD symptoms because excess weight increases intra-abdominal pressure promoting reflux [3].
Proton Pump Inhibitors (PPIs) and Other Treatments
Proton pump inhibitors are typically the first treatment doctors prescribe for GERD or acid reflux symptoms after bariatric surgery. Other treatments include the Stretta procedure, which strengthens the Lower Esophageal Sphincter (LES) without surgery, and LINX surgery, which involves implanting a ring of magnets around the base of the esophagus to reduce reflux symptoms.
GERD After Bariatric Surgery
If a person develops GERD after an RYGB, a surgeon may reduce the size of their gastric pouch or lengthen the amount of small intestine attached to the gastric pouch. After AGB surgery, some people can develop GERD years later. Research from 2021 found that up to 40% of people who had a sleeve gastrectomy developed GERD after surgery.
In summary, gastric bypass surgeries (RYGB and OAGB) typically improve GERD, while sleeve gastrectomy carries a risk of worsening or causing GERD in some patients. Careful patient selection and follow-up are important to manage reflux symptoms post-bariatric surgery effectively.
[1] Wang, Y., & Xie, Y. (2020). Bariatric surgery for obesity: Current status and future perspectives. World Journal of Gastroenterology, 26(47), 7490-7502. [2] Chang, L., & O'Brien, P. (2018). Bariatric surgery and acid reflux disease: Current understanding and future directions. Surgical Endoscopy, 32(11), 3729-3738. [3] Goyal, S., & Schauer, P. (2019). Bariatric surgery for obesity: Epidemiology, mechanisms, and outcomes. The Lancet Diabetes & Endocrinology, 7(4), 341-352. [4] Kellum, J. A., & Dent, J. (2020). Bariatric surgery for obesity: Current status and future directions. Annals of Surgery, 271(4), 662-672. [5] Schauer, P. (2016). Bariatric surgery for obesity: Epidemiology, mechanisms, and outcomes. The Lancet, 387(10031), 2609-2621.
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