Why Gastroesophageal reflux disease (GERD) may occur or worsen after bariatric surgery

Gastroesophageal reflux disease (GERD) is a chronic condition that affects a significant number of individuals who have undergone bariatric surgery. It occurs when stomach acid and bile flow back into the esophagus, causing symptoms such as heartburn, regurgitation, and difficulty swallowing. While bariatric surgery is an effective treatment for obesity, it can sometimes lead to the development or worsening of GERD symptoms.

Why Does GERD Occur After Bariatric Surgery?

There are several reasons why GERD may occur or worsen after bariatric surgery:

Changes in Anatomy: Bariatric surgery alters the anatomy of the stomach and intestines, which can affect the normal functioning of the lower esophageal sphincter (LES). The LES is a muscular ring that prevents stomach acid from flowing back into the esophagus. When the LES becomes weakened or relaxed, it can lead to GERD.
Increase in Intra-abdominal Pressure: Some bariatric procedures, such as gastric banding, can increase intra-abdominal pressure. This pressure can push stomach acid and bile up into the esophagus, causing GERD symptoms.
Dietary Changes: After bariatric surgery, individuals are often advised to follow a strict diet that includes smaller, more frequent meals. However, certain foods and beverages, such as fatty or spicy foods, caffeine, and alcohol, can trigger or worsen GERD symptoms.

When Should Revisional Bariatric Surgery be Considered?

If a patient experiences persistent or severe GERD symptoms after bariatric surgery, revisional surgery may be considered. The decision to undergo revisional surgery should be made in consultation with a healthcare professional who specializes in bariatric surgery.

Some indications for revisional bariatric surgery in the context of GERD include:

Failure of conservative management, such as lifestyle modifications and medication therapy, to adequately control GERD symptoms.
Complications related to GERD, such as esophageal strictures, Barrett’s esophagus, or respiratory problems.
Significant weight regain or inadequate weight loss after the initial bariatric procedure.

Types of Revisional Bariatric Procedures for GERD

There are several revisional bariatric procedures that can be considered for the management of GERD:

Gastric Bypass Revision: In some cases, converting a previous bariatric procedure, such as gastric banding, to a gastric bypass can help alleviate GERD symptoms. Gastric bypass surgery involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing the rest of the stomach and the LES.
Conversion to Sleeve Gastrectomy: Another option is converting a previous bariatric procedure to a sleeve gastrectomy. This procedure involves removing a portion of the stomach to create a smaller, banana-shaped stomach. It can help reduce the occurrence of GERD symptoms by decreasing the production of stomach acid.
Hiatal Hernia Repair: If a hiatal hernia is contributing to GERD symptoms, a revisional procedure may involve repairing the hernia. This can help restore the normal anatomy and function of the LES.

Conclusion

GERD is a common indication for revisional bariatric surgery. It can occur or worsen after bariatric procedures due to changes in anatomy, increased intra-abdominal pressure, and dietary factors. If conservative management fails to control GERD symptoms or if complications arise, revisional surgery may be considered. Various revisional procedures, such as gastric bypass revision, conversion to sleeve gastrectomy, or hiatal hernia repair, can help alleviate GERD symptoms and improve patient outcomes.