Expert answers: How does weight loss surgery affect patients with GERD?

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May 13, 2020 | Ellen Bissonette, RN, CBN | @ecb

Written by Todd Kellogg, M.D., a Mayo Clinic surgeon

Because overweight and obesity are important risk factors for gastroesophageal reflux disease (GERD), it is not surprising that many people seeking weight loss surgery have a history of GERD.  For some it’s just a nuisance but for others it is a real problem that requires multiple medications for adequate control of the symptoms.

The two most commonly performed weight loss surgeries are the sleeve gastrectomy and the Roux-en-Y gastric bypass (RYGB).  These two operations affect people with GERD in completely different ways so it’s important to understand the differences.

The sleeve gastrectomy is almost guaranteed to make pre-existing GERD worse.  What is more is that those without GERD before sleeve gastrectomy have a 1 in 5 chance of developing GERD after undergoing sleeve gastrectomy.  If someone seeking weight loss surgery has GERD and is already having difficulty controlling their symptoms with medications, a sleeve gastrectomy is not recommended.  Uncontrolled GERD after sleeve gastrectomy is a miserable condition and generally requires conversion to Roux-en-Y gastric bypass to manage symptoms.  However, if symptoms are mild or easily controlled with a single medication then people can still undergo a sleeve gastrectomy without much risk of developing problematic GERD symptoms.

On the other hand, the Roux-en-Y gastric bypass operation is a very good operation for patients with GERD whether it is due to acid reflux or bile reflux.  The reason for this is that this operation bypasses the far majority of the acid producing portion of the stomach and eliminates the path for bile to reach the bottom of the esophagus.  Everyone who has pre-existing GERD has improvement after the RYGB and for some GERD will resolve completely.  It should be noted that there are a few people who continue to have GERD symptoms after RYGB and this is most often due to misguided eating and drinking behaviors such as eating or drinking too much, too fast, or both.  Rarely, GERD symptoms can persist after RYGB despite appropriate eating and drinking behaviors.  In these cases symptoms can usually be controlled with the addition of an antacid medication.

In summary, overweight and obesity are risk factors for GERD.  Different weight loss operations affect GERD in opposite ways.  The sleeve gastrectomy can cause GERD and can make pre-existing GERD worse.  The RYGB is a very good operation for the treatment of GERD.  Most people with pre-existing GERD will have improvement or complete alleviation of their symptoms after RYGB.

Connect with others talking about GERD and Roux-en-Y gastric bypass in the Digestive Health support group.