Gastroesophageal Reflux Disease is a serious matter and should not be left untreated. It is know as heartburn or reflux and if you are experiencing more than twice a week you should be evaluated by a physician to investigate the cause. Listed below are some of the causes and end results of not treating GERD.
Esophagitis – An irritant that can be acid, bile, food and digestive enzymes coming back up the esophagus can cause irritation and swelling in the esophagus. If left untreated, it can damage the lining of the esophagus to the point of erosion and scarring. Bile Reflux may also be a cause of esophagitis and Duodenogastroesphogeal reflux (DGER). Bile Reflux information here.
Esophageal Stricture – Scar tissue can cause the lumen of the esophagus to become smaller and narrow. This stricture makes it difficult or painful to swallow foods. If a stricture is narrow enough food may become stuck and require intervention for removal and treatment. This can also put a person at risk for choking. The treatment includes ballon dilation with an endoscope and in cases where it recurs surgery may be required.
Esophageal Ulceration– If GERD is left untreated it can progress to actual ulcerations in the esophagus. Patients may cough up or vomit blood or see it in their stool as dark tarry or coffee ground type stool.
Gastric Stricture– After weight loss surgery such as sleeve gastrectomy, RNY Gastric Bypass, Duodenal Switch, SADI/Loop, Adjustable Gastric Banding, or other gastric surgeries a narrowing of the inner opening of the stomach can result from scar tissue forming. This will require a surgical procedure to rectify. The symptoms can be food intolerance, full feeling, nausea and/or vomiting. (See pictures below)
Hiatal Hernia– An anatomical weakening or enlargement of the opening of the diaphragm muscle where the esophagus meets the stomach. This defect can allow a portion of the stomach to slide or roll into the chest cavity. This then causes reflux of gastric juice and content. Hiatal Hernia’s can also form on weight loss surgical patients. There are several examples within this blog here.
Breathing Difficulties– The acid aspiration while sleeping can make asthma and other breathing difficulties worst and can cause coughing and other issues.
Dental Issues – The acid, food, digestive enzymes backing up into the esophagus and mouth can cause dental issues such as erosion and tooth decay. In regards to dental issues after weight loss surgery there are also other vitamin and mineral deficiencies that can cause oral health issues. Dental Issues after WLS here.
Lower Quality of Life– GERD can affect a person’s quality of life. If you are in discomfort from acid reflux or having food intolerance it can make life difficult. It can also alter food choices and impact nutrition.
Barrets Esophagus– Pre-cancerous changes in the bottom portion of the esophagus due to long term acid exposure from gastric reflux. Diagnosis requires and endoscopic procedure (EGD) and biopsy.
Esophageal Cancer– There is a significant rise in the western world in esophageal adenocarcinoma. The main risk factors are alcohol use, smoking, untreated GERD, and poor diet.
Reflux and difficulty with swallowing caused by stricture is not normal. These problems are quite frequently encountered as complication of Adjustable gastric banding, with slipped band or a band that is too tight and scarred in placed resulting is belt effect. This results in the esophagus not being able to empty and propel the food down. The end result is significant reflux, with difficulty swallowing, nausea, vomiting etc. Similar problems are seen with Gastric bypass where the anastomosis between the stomach pouch and the small bowel RNY limb is too narrow. In Gastric Sleeve and Duodenal Switch operations, is the sleeve is made too narrow, or misshaped (hour glass, funnel, cork screw) it will result in the patient having reflux and symptoms of stricture. One specific problem with the new operation of SADI is the concern for risk of bile reflux, similar to the BillRoth I procedure.
Gastric bypass patient with stricture at the gastro-jejunostomy before and after balloon dilation. Fig A
After balloon dilation. Fig B
Fig. C : Lap band Patient with stricture where the band as removed at another facility and the scar tissue formed around the GE junction was not taken down. The patient had to be taken back to the operation room after his symptoms persisted even though the band had been removed 3 months prior.
A corkscrew stomach of a Duodenal Switch done at another facility, with the patient presented with persistent reflux, nausea and vomiting for years after surgery. Fig. D
This is not an inclusive discussion of GERD and the treatment. Please see your healthcare providers if you are experiencing any symptoms pertaining to GERD or any other health care issue.
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In situations with SADI with Bile Reflux what is the recommended treatment?
Hello, Revision to the duodenal switch operation will resolve the issue of bile reflux. This needs to be done with the proper length of the small bowel, to not only solve the bile reflux, but also the weight issue that prompted the SADI procedure to begin with. The risk of Bile reflux was discussed in a 2014 blog.
Thank you
This is a great blog Dr K. As you know my family has significant history with GERD. Left untreated it can be debilitating and as you point out, can even lead to esophageal cancer. I am active on a bariatric veterans site and advise people who have recently had a DS to watch closely for symptoms of GERD and see their surgeon or PCP for a PPI if need be.
Thank you for your comment. The cause of GERD is important to identify and treat. PPI’s have their place short term but can be covering an underlying issue. PPI use has not shown a decrease in gastric cancer rates and they have been associated with increase in pneumonia, C.diff, osteoporosis, malabsorption of calcium, magnesium, iron, and medications.
Hi ,there. Dr Ara. I was told about you from a Turkish Surgeon. I have ended up with bile in my stomach from day 1 after gallbladder surgery . I have spoke to other surgeons here in Missouri where I’m from and none of them are willing to keep my pyloric valve. They say a bile diversion is not done that way. As the research I have done , you most definitely want to do that. As well the surgeon next Turkey told me that as well. I’m really wanting some help with finding out how and what I need to do to reach you in hopes of find a better life as of now I suffer and have no quality of life. Your reply would mean the world to me. Thank you so much
Hello i got gastric sleeve last month and since day 1 i can not eat anything other then liquids. if i eat i vomit thick mucus first three times before the food comes up. they have already stretched my tube on Friday and today same thing again i can not eat. is this called Gerds
GERD, refers to reflux. What you are describing is not reflux but possibly a stricture because of the sleeve. See your surgeon for further evaluation and treatment.
I have congenital gastroparesis and also no lower esophageal sphincter. I have had 4 failed Nessons since age 18 mo (they worked a while). 2.5 years ago I had a RNY to try to control my reflux and to loose weight. I lost 160# with current BMI 32.5. My reflux was controlled for about 1 year. I now have non acidic reflux to my mouth several times a day and have to sleep sitting to help prevent aspiration. I am now oxygen dependent due to frequent aspiration causing pneumonia, scaring and inflammation. Would a DS help and if not, any suggestions?
The duodenal switch will not help with reflux. Unfortunately do not have detail to know what else are your alternatives. It is however surprising that you are having reflux after RNY. An experienced surgeon needs to evaluate that operation, including doing an upper GI to make sure you do not have a hiatal hernia. If you do that will require surgery with hiatal hernia repair with mesh (because you have had three previous operations). A gatro-gastric fistular should also be ruled out.
please see the links below:
https://www.dssurgery.com/?s=fistula
https://www.dssurgery.com/gastro-gastric-fistula-after-gastric-bypass-operation/
I have just been for a barium swallow & it has been confirmed that I have a structure in my sleeve in the shape of an S. they said it will be referred to surgeon to review & contact me further.
I suffer with severe GERD food intolerances, vomiting & changes have been horrid lately. I am losing weight as I am struggling with even my ‘safe’ foods now. Is this likely to end up in an operation? If so, what type is it likely to be? No one seems to be able to give me an answer & I’m terrified of living the rest of my life like this. I had my operation privately at irmet in Turkey in 2019 & have been suffering since. It’s taken until now to be taken seriously in the uk sadly
Strictures are seen occasionally with Sleeve and even Gastric bypass. It may need surgical intervention.
Thank you for this reply. Is there any advice you could give me on what type of surgeries this could be? Is it likely to be a gastric bypass? I have an ‘s’ shape in the middle of my sleeve & oesophageal dysmotility as-well. The person that did the X-ray said the sleeve doesn’t look like a normal sleeve gastrectomy & the staple line cannot be identified.
Many thanks