Persistent Heartburn after Gastric Sleeve to Bypass Conversion

Persistent Heartburn after Gastric Sleeve to Bypass Conversion

Jennifer from Houston sent us this question: “I just had conversion from sleeve to bypass along with hiatal hernia repair for GERD. It’s been a month. Started having reflux again about 2 weeks out 😭”.

Dear Jennifer,

I am not sure what do you mean by having “reflux” again. Acid reflux is a medical disease diagnosed by an acid reflux specialist. Reflux is not a symptom. Heartburn, food regurgitation, cough, globus and epigastric pain are symptoms commonly experienced by patient with acid reflux disease. Symptoms however do not always correlate with acid reflux disease presence and severity. Therefore, the first thing I recommend to patients with recurrent acid reflux related symptoms after anti-reflux surgery, is to repeat upper endoscopy with ambulatory pH testing. 24-hour pH impedance may be added to check for non-acid reflux especially in the case of gastric bypass.

Gastric bypass is an effective anti-reflux procedure. Fast gastric pouch emptying into alimentary limb contribute to acid reflux control. Furthermore, diverting most of the stomach acid away from esophagus further add to acid reflux control.  A short alimentary limb may result in bile reflux into esophagus. Treatment in this case consists of lengthening the alimentary limb. A gastro-gastric fistula, a connection between remnant stomach and gastric pouch may also lead to acid reflux. This condition is less likely to occur in cases of sleeve to bypass conversion. Lastly, if your bariatric surgeon resected most of the remaining gastric sleeve during sleeve to bypass conversion, a retained gastric antrum syndrome may occur. Retained gastric natrum syndrome is characterized by elevated gastrin levels in the blood. Gastrin stimulates acid secretion in gastric pouch. Gastrin hormone is secreted by G cells located in stomach antrum. Stomach acid inhibits gastrin hormone secretion. An unresected gastric antrum constantly exposed to bile from the duodenum and no acid from the stomach, may lead to elevated gastrin hormone blood levels. Treatment in this case consist of gastric antrum resection.

Irrespective of cause, proper evaluation by an acid reflux specialist and bariatric surgeon in Houston is highly recommended to choose the most effective solution for your problem.