Heartburn – Reflux after weight loss surgery
One of the most common complaints that leads to revision (re-operation) weight loss surgery is the complaint of heartburn or reflux symptoms. Often the symptoms experienced by the patients are caused by other reasons than acid alone.
The symptoms of heartburn and reflux can be caused by:
- Acid reflux
- Bile reflux
- Regurgitation
- Herniation of the stomach pouch into the chest
- Stricture formation
- Torsion (twisting of the stomach)
- Eating fast and big bites of food
The main cause of GERD after a weight loss operation specifically the gastric sleeve may be simple anatomy. We are keeping the two valves at the top and bottom of the stomach intact, however we are reducing the size of the stomach by about 70%. This increases the pressure in the stomach significantly and therefore may cause a greater likelihood of reflux. We are also seeing that bile has an easier time of refluxing up the stomach as well. When bile is identified as the cause – surgery is often required to divert the bile away from the stomach and esophagus. There can also be mechanical reasons for the symptoms that feel like heartburn. When the stomach herniates into the chest particularly after repeated episodes of heaving and retching it can create additional obstructive symptoms that present itself as heartburn/reflux. Similarly this may occur with strictures and twisting of the stomach pouch.
As with any other heartburn it is recommended to avoid food that can trigger heartburn. Most common triggers are considered to be citrus, pineapple, kiwi, tomato, onion, garlic, peppermint, chocolate, ice-cream, caffeine, egg yolk, pastries and foods that contain a lot of fat, including fat-rich dairy products.
The same medications used for regular heartburn work to control the symptoms with heartburn after weight loss surgery. Examples of antacids are: Prilosec® (omeprazole), Prevacid® (lansoprazole), Dexilant® (dexlansoprazole), Nexium® (esomeprazole), Protonix® (pantoprazole), AcipHex® (rabeprazole), Pepcid and Nexium. Over-the-counter brands of these antacids, if available, are also acceptable. Speak with your doctor or bariatric surgeon before starting treatment.
When diet changes, elevation of the head of the bed, and medications do not work, or stop working effectively it is very important to speak with a bariatric Surgeon to help determine and understand why the heartburn is so severe. Often a correctable cause can be identified. Often a surgical intervention may be required.
It is also important to understand that prolonged use of antacids specifically PPI’s (Prilosec® (omeprazole), Prevacid® (lansoprazole), Dexilant® (dexlansoprazole), Nexium® (esomeprazole), Protonix® (pantoprazole)) at higher dosages for prolonged periods of time are associated with serious side effects. More serious side effects include kidney disease, fractures, infections and vitamin deficiencies, but these are rare and are generally associated with long-term use (using these products for more than a year).
It is recommended for all weight loss surgery patients experiencing heartburn after weight loss surgery to speak with their bariatric surgeon. Frequently endoscopy may be performed to rule out any problems with your weight loss operation before letting you take medications for a prolonged period of time.