Jenny from Humble sent us this question: “Had sleeve done in 2014. After EGD done 1/2020 it showed I had lots of bile in my stomach. Have bile reflux, take 40mg Omeprazole DR twice a day. Still have burning in throat, chest, esophagus. Also having hiccups and belching after eating. Cut out all caffeine, sodas, acidic fruits, and tomatoes. Still no difference. Also fried foods. Just hurting when I eat anything. EGD also showed esophagitis. 65 and getting tired of all of this daily. Will go to Dr. 5/21. Just asking for more advice or what I can do. Thanks JD”.

Dear Jenny,

Bile gastritis and bile reflux after sleeve gastrectomy is indicative of hiatal hernia. Hiatal hernia is a defect in the diaphragm hiatus. The diaphragm or breathing muscle has an opening in its center. The esophagus or food pipe goes through this opening to join the stomach in the abdominal cavity. The opening is wide enough to allow for the esophagus to go through. If the opening is large a hiatal hernia forms and the stomach herniates through the hiatal hernia into the chest.

Obesity is a major risk factor for hiatal hernia formation. Most overweight individuals have a hiatal hernia. Therefore, most obese patients undergoing sleeve gastrectomy must have a concomitant hiatal hernia repair. If hiatal hernia is not repaired, gastric sleeve herniates into the negative pressure area of the chest. This results in bile reflux from the duodenum into the stomach lumen and eventually ending in the esophagus.

Bile reflux may be worse than acid reflux in terms of damage to esophagus lining, severe burning symptoms and esophageal cancer development. Most importantly, bile reflux does not respond to proton pump inhibitors like Omeprazole and Nexium. I strongly recommend you consult with the best acid reflux and weight loss surgery specialist in your area to get evaluated and treated. Hiatal hernia repair is quite effective at stop bile reflux especially if gastric sleeve lumen is not narrowed or twisted.