Gastric bypass, or the Roux-en-Y gastric bypass (RYGB), is a type of bariatric or weight loss surgery. It’s done to promote weight loss and manage obesity.
In people with GERD, gastric bypass surgery can help. But sometimes it can make GERD more severe.
Let’s explore the link between GERD and gastric bypass and how it compares with other weight loss surgeries.
The lower esophageal sphincter (LES) is a ring of muscle found at the bottom of your esophagus. It connects your esophagus to your stomach.
Normally, the LES stays closed to protect your esophagus from the acidic contents of your stomach. When you eat, it opens to let food pass through.
But if the LES is weak or other factors are present, it might let the contents flow back into the esophagus. This can cause acid reflux, also called gastroesophageal reflux.
GERD occurs when acid reflux is chronic. You might be more likely to experience GERD if you have overweight or obesity.
Gastric bypass is the most common weight loss surgery. It involves dividing the stomach into a small upper pouch and a large lower pouch. The small intestine is then divided and connected to both. This creates a “Y” shape.
The surgery affects GERD because it alters the following factors:
- pressure on the LES
- acid production
- your esophageal reflux
According to a
In a small 2020 study, researchers examined the prevalence of GERD after different weight loss surgeries. This included gastric bypass and laparoscopic sleeve gastrectomy (LSG), or gastric sleeve surgery.
They found that GERD was more likely to affect people who received gastric sleeve surgery compared with those who received gastric bypass.
Similarly, according to a
A gastric bypass surgery can improve GERD in several ways:
- reducing acid production into the small upper pouch
- decreasing esophageal reflux (due to the “Y” shape of the rearranged organs)
- reducing exposure to stomach acid in the esophagus
- increasing how fast the contents in the upper pouch are emptied
- promoting weight loss
- reducing abdominal pressure on the LES (due to a smaller stomach and weight loss)
But gastric bypass might not resolve GERD in everyone.
According to a
According to the researchers, this might be due to the gastric pouch being too large, causing continuous acid production. In other cases, the rearranged organs might cause bile to flow backward.
GERD may also be affected by other types of weight loss surgeries:
In a sleeve gastrectomy, or gastric sleeve surgery, about 80 percent of the stomach is removed. This makes the size and shape of the stomach similar to those of a banana.
The surgery is simpler than other types of weight loss surgery. But it can cause or worsen GERD.
According to a 2021 review, 84.1 percent of people with GERD still had it after gastric sleeve surgery. What’s more, 44 percent of people experienced more acid reflux 18 months after the procedure.
A 2021 study also determined that up to 40 percent of people who receive a gastric sleeve develop GERD.
The higher rate of GERD after receiving a gastric sleeve may be related to:
- reduced LES pressure
- reduced stomach volume
- reduced gastric emptying
- narrow shape of the stomach
Adjustable gastric band (AGB)
An AGB, also called a gastric band or lap band, is a silicone device that’s placed around the upper stomach. It makes the stomach smaller, which reduces the amount of food you can eat.
According to a
The review notes that after the surgery, GERD symptoms decreased from 33.7 percent to 7.7 percent. At the same time, 15 percent of people studied developed GERD after the surgery.
According to the researchers, the placement of the band might promote GERD symptoms by increasing pressure.
Treatment for acid reflux or GERD after gastric bypass involves the usual treatment for both conditions.
A doctor might recommend:
Lifestyle changes are key for treating GERD. This may include:
- losing weight or maintaining a moderate weight
- raising your head on extra pillows during sleep
- avoiding meals at least 3 hours before bedtime
- quitting cigarette smoking, if you smoke (this can be difficult, but a doctor can build a cessation plan that works for you)
- eating a balanced diet
- limiting foods or beverages, such as carbonated drinks, that make your GERD symptoms worse
The first-line medications for acid reflux and GERD are proton pump inhibitors. These drugs work by reducing acid production in your stomach.
A doctor might also recommend:
- Antacids. Antacids neutralize the acid in your stomach.
- H2 blockers. H2 blockers work by reducing acid production.
- Prokinetic agents. Prokinetic drugs strengthen the contractions of your LES, as well as the muscles the in your digestive tract.
If lifestyle changes and medications fail to control your GERD, you might need surgery. This includes gastric bypass (RYGB) as well as:
Fundoplication involves sewing the upper stomach around the bottom of your esophagus. This increases pressure on the LES, which reduces acid reflux.
This procedure is the most common surgery for acid reflux and GERD.
This surgery involves a ring of metal beads. The beads are connected by a magnet.
The ring is implanted around your lower esophagus, where it closes the LES. This prevents the stomach contents from flowing back into the esophagus.
When you swallow, the beads separate so food can move through.
This procedure involves an endoscope, or a flexible tube with a light and camera at one end, fitted with a tool that delivers thermal energy. This emits a radiofrequency, which strengthens the LES.
Without treatment, GERD can lead to:
After gastric bypass surgery, it’s important to follow up with a doctor. This will allow them to check for negative outcomes and ensure you’re healing properly.
See a doctor if you notice new or worsening GERD symptoms, such as:
- chest pain
- difficulty swallowing (dysphagia)
- pain while swallowing
- chronic coughing
- hoarse voice
You should also get medical help if you have:
- fast heart rate
- stomach pain
- low blood pressure
- drainage (seeping) from the surgical site
- reduced urine production
- pain in the left shoulder
These symptoms may indicate negative outcomes related to gastric bypass.
If you have GERD and need weight loss surgery, gastric bypass might be the best choice. This procedure can help relieve GERD by reducing acid production, abdominal pressure on the lower esophagus, and esophageal reflux.
Other weight loss surgeries, such as gastric sleeve and gastric band surgery, might cause or worsen GERD. However, the best option depends on your GERD symptoms and underlying medical conditions. A doctor can determine whether gastric bypass is right for you.