Gastric Bypass Surgery, or Ruwai Gastric Bypass Surgery (RYGB), is a type of obesity or weight loss surgery. It is done to promote weight loss and manage obesity.
Obesity increases the risk of gastroesophageal reflux disease (GERD). Gastroesophageal reflux disease causes acid reflux disease that occurs when the contents of the stomach flow back into the esophagus.
Gastric bypass surgery can help in people with gastroesophageal reflux disease. But sometimes it can make GERD more severe.
Let’s look at the relationship between gastroesophageal reflux disease and gastric bypass surgery and a comparison with other weight loss surgery.
The lower esophageal sphincter (LES) is the ring of muscle at the bottom of the esophagus. It connects your esophagus to your stomach.
Normally, LES remains closed to protect the esophagus from the acidic contents of the stomach. When you eat, it opens to allow food to pass through.
However, if the LES is weak or other factors are present, the contents can flow back into the esophagus. This can cause acid reflux disease, also known as gastroesophageal reflux disease.
Gastroesophageal reflux disease occurs when acid reflux is chronic. If you are overweight or obese, you are more likely to experience GERD.
Gastric bypass surgery is the most common weight loss surgery. It involves dividing the stomach into a small upper pouch and a large lower pouch. Then the small intestine is split and connected to both. This creates a “Y” shape.
Surgery affects GERD because it changes the following factors:
- Pressure on LES
- Acid production
- Your esophageal reflux disease
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In a small study in 2020, researchers examined the prevalence of GERD after various weight loss surgeries. This includes gastric bypass surgery and laparoscopic sleeve gastrectomy (LSG), or gastric sleeve surgery.
They found that GERD was more likely to affect people who had gastric sleeve surgery than those who had gastric bypass surgery.
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Gastric bypass surgery can improve GERD in several ways.
- Reduces acid production on the small upper pouch
- Reduction of esophageal reflux disease (due to the “Y” shape of the reorganized organs)
- Reduces exposure of the esophagus to stomach acid
- Increase the speed at which the contents of the upper pouch are emptied
- Promote weight loss
- Reduces abdominal pressure on LES (stomach becomes smaller and loses weight)
However, gastric bypass may not solve GERD for everyone.
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According to researchers, this may be due to the stomach being too large, causing continuous acid production. In other cases, the rearranged organs can regurgitate bile.
GERD may also be affected by other types of weight loss surgery.
Sleeve gastrectomy
With sleeve gastrectomy or gastrectomy, about 80% of the stomach is removed. This will make the size and shape of the stomach the same as a banana.
Surgery is easier than other types of weight loss surgery. However, it can cause or exacerbate GERD.
Similar to the above study, a small study in 2020 found that having a gastric sleeve was associated with GERD. A
According to a 2021 review, 84.1% of GERD patients still suffered from gastroesophageal reflux disease after gastric sleeve surgery. In addition, 44% experienced more acid reflux 18 months after surgery.
A 2021 study also found that up to 40% of people who received a gastric sleeve develop GERD.
The high incidence of GERD after receiving a gastric sleeve may be related to:
- LES pressure drop
- Decrease in stomach volume
- Reduced gastric emptying
- The shape of the stomach is narrow
Adjustable stomach band (AGB)
AGB, also known as a stomach band or wrap band, is a silicon device placed in the upper part of the stomach. It makes the stomach smaller and reduces the amount of food you can eat.
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According to reviews, GERD symptoms decreased from 33.7% to 7.7% after surgery. At the same time, 15 percent of the people studied developed GERD after surgery.
According to researchers, band placement can promote GERD symptoms by increasing pressure.
Treatment of acid reflux disease or GERD after gastric bypass surgery includes conventional treatment for both conditions.
Your doctor may recommend the following:
Lifestyle changes
Lifestyle changes are the key to treating GERD. This includes:
- Lose weight or maintain a moderate weight
- Raise your head with an extra pillow while you sleep
- Avoid eating at least 3 hours before bedtime
- If you smoke, quit smoking (this can be difficult, but your doctor can make a quit smoking plan to work for you)
- Eat a balanced diet
- Restrict food and drink such as carbonated drinks that exacerbate the symptoms of gastroesophageal reflux disease
dosage
The first-line drug for acid reflux disease and GERD is a proton pump inhibitor. These medicines work by reducing the production of acid in the stomach.
Doctors also recommend:
- Antacid. Antacids neutralize the acid in the stomach.
- H2 blocker. H2 blockers work by reducing the production of acid.
- Exercise promoter. Exercise promoters enhance not only the muscles of the gastrointestinal tract, but also the contraction of LES.
Surgery
Surgery may be required if lifestyle changes and medications do not control gastroesophageal reflux disease. This includes gastric bypass (RYGB) and:
Cardiaclasty
In cardiaclasty, the upper abdomen is sewn to the bottom of the esophagus. This increases the pressure on the LES and reduces acid reflux.
This procedure is the most common surgery for acid reflux disease and GERD.
LINX surgery
This surgery involves a ring of metal beads. The beads are connected by magnets.
The ring is embedded around the lower esophagus, where it closes the LES. This prevents the contents of the stomach from flowing back into the esophagus.
When swallowed, the beads separate and allow food to pass through.
Stretta procedure
This procedure involves a flexible tube with a light and camera at one end, fitted with an endoscope or a tool that supplies heat energy. It emits radio frequencies that enhance the LES.
Without treatment, GERD can lead to:
It is important to see a doctor after gastric bypass surgery. This allows them to check for negative results and make sure you are healing properly.
Seek medical attention if you notice any new or worsening GERD symptoms such as:
You may need to see a doctor if:
These symptoms may have negative consequences associated with gastric bypass.
If you have GERD and need weight loss surgery, gastric bypass may be the best choice. This procedure helps relieve GERD by reducing acid production, abdominal pressure on the lower esophagus, and esophageal reflux disease.
Other weight loss surgeries, such as gastric sleeve and gastric band surgery, can cause or exacerbate GERD. However, the best option depends on the symptoms of GERD and the underlying medical condition. Your doctor can determine if gastric bypass is suitable for you.
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