Gastric Bypass Long-term Complications

I am a 64 y/o female, 20 years post roux-en-y gastric bypass. I have GERD, a “small” hiatal hernia, Barrett’s esophagus, nighttime bile regurgitation, and bilious vomiting after any decent sized meal. I continue to get worse each year. My GI doctor does not believe it is possible for a gastric bypass patient to have GERD. He believes I simply misunderstand the meaning of GERD. I am so frustrated and miserable. Where should I go from here?

Dear Deborah,

GERD is possible but not likely in gastric bypass patients. At Houston Weight Loss Surgery Center, I treat around 5 gastric bypass patients a year with newly diagnosed GERD. Almost all gastric bypass patients with GERD that I have treated have Barrett’s esophagus. Barrett’s esophagus does not develop in the absence of GERD and is a strong indicator of advanced reflux. Barrett’s esophagus is likely to develop secondary to bile reflux especially in the setting of gastric bypass since there is minimal acid production in the small gastric pouch. In your case, the likelihood of bile reflux is high since you report bilious vomiting and regurgitation.

My recommendations for you is to get evaluated by an experienced reflux specialist and bariatric surgeon. An upper endoscopy and UGI contrast study will help your bariatric surgeon evaluate the anatomy of gastric bypass, check the size of hiatal hernia, measure the length and diameter of the Roux limb and rule out a gastro-gastric fistula. Abnormal gastric bypass anatomy that favors bile reflux includes a short Roux limb or narrowed jejuno-jejunostomy outflow channel. A gastro-gastric fistula develops when the staple line between the gastric pouch and stomach remnant breaks down. A connection between both gastric pouches favors acid and bile passage into the gastric pouch and up into the esophagus. Additional testing may be requested like a CT scan of abdomen and pelvis to rule out an internal hernia causing partial obstruction and favoring bile reflux. Depending on the etiology of your GERD, a solution can be offered.

It is hard to live with daily reflux and vomiting. It is obvious that you have a problem and it is definitely not normal to have such symptoms with gastric bypass. You need help.