Acid reflux is a common symptom that many people struggle with before they undergo gastric bypass surgery. While weight loss surgery often treats reflux, the anatomical changes made to your digestive tract during the gastric bypass procedure sometimes makes it easier for acid to enter your esophagus. If you are struggling with acid reflux after gastric bypass, learn why you may be experiencing this painful symptom and try these tricks to reduce gastric bypass reflux and improve your quality of life.

What is Acid Reflux?

Acid reflux is where acid from the stomach enters the esophagus. Stomach acid can irritate the lining of your esophagus, giving you the feeling of a burning sensation. It is normal to experience acid reflux once in a while, especially if you have had food that is especially irritating to your digestive system. When it occurs frequently, it is called gastroesophageal reflux disease (GERD).

Acid reflux is often managed with lifestyle changes, medication, and, sometimes, in severe cases, requires surgery.

Symptoms of acid reflux include:

• A burning sensation in your chest (often referred to as heartburn)
• Difficulty swallowing
• Chest pain
• Sore throat or feeling like you have a lump in your throat
• Tasting sour liquid that is from regurgitated stomach contents

People often experience acid reflux at night because they are lying flat. Nighttime acid reflux can impact your sleep quality, give you a chronic cough, cause throat infections (like laryngitis), and worsen lung diseases like asthma. Sometimes, people sleep upright in a chair to manage nighttime reflux.

A weakened lower esophageal sphincter causes acid reflux. Your lower esophageal sphincter (LES) is a muscular band of tissue that serves to keep stomach contents in your stomach. When this sphincter weakens, it can release these contents into your esophagus and even up into your throat. The weakening of the LES is caused by:

• Obesity
• Hiatal hernia (this is where the top of your stomach bulges into the diaphragm, putting pressure on your LES)
• Delayed stomach emptying
• Pregnancy
• Connective tissue disorders

You can experience long term complications from acid reflux if you do not seek treatment or make lifestyle changes. Difficulties often arise because your esophageal tissue becomes chronically inflamed. For example, chronic inflammation can lead to narrowing of the esophagus, esophageal ulcers, and precancerous changes to your esophageal tissues (called Barrett's esophagus).

What is Gastric Bypass Surgery?

Weight loss is essential if you are overweight and are struggling with reflux. Some people are unable to lose a sufficient amount of weight without weight loss surgery.

Gastric bypass surgery is one of the most popular and successful bariatric procedures in the United States. Gastric bypass can help people lose between 60-80% of their excess weight, and it can help treat diseases related to obesity.

There are two predominant steps performed during gastric bypass surgery. Firstly, the bariatric surgeon creates a small pouch out of the upper portion of the stomach. Secondly, the surgeon then attaches the new, smaller stomach pouch to the small intestine's bottom end. These changes severely alter the normal flow and absorption of digestive contents to help people lose weight. Another aspect of gastric bypass surgery is that it changes the hormones in your gut, making you feel full more quickly.

Why Does Gastric Bypass Reflux Happen?

The relationship between gastric bypass and acid reflux is complicated. While many people have an improvement in GERD following surgery, some people find it worsens. One of the reasons why reflux may worsen in because your stomach size becomes much smaller after surgery (usually limiting your stomach to hold one ounce or 30 millimeters). Thus, your LES can become more prone to stretching and relaxing, especially with overeating.

Anatomical problems, such as strictures, may cause GERD.

Your gut microbiome may also change when your digestive tract is shortened. Certain bacteria are more prone to causing GERD, and these opportunistic bacteria may become overpopulated following surgery. Changes in your gut microbiota after gastric bypass may also affect your gastric pH and the metabolism of bile acids.

Tricks to Managing Acid Reflux After Gastric Bypass Surgery

You cannot always prevent acid reflux. However, certain factors can aggravate this condition. Let's examine ways to decrease your risk for acid reflux after gastric bypass surgery.

Stop smoking.

Smoking cessation is essential if you want to improve your health and longevity. Not to mention, smoking is one of the leading preventable factors causing acid reflux. If you need help to quit smoking, talk to your doctor about medication and behavioral therapy to help you overcome this addiction.

Prepare ahead for surgery.

If you are thinking about gastric bypass, now is the time to familiarize yourself with gastric bypass surgery requirements. People who start to lose a little bit of weight before surgery and who follow all of the dietary recommendations, such as the pre-op liquid diet, are more likely to have good outcomes.

Lose excess weight.

If you are considering weight loss surgery, you are already on the right track to losing weight. Excess weight exerts pressure on your abdominal organs, making it easier for digestive fluids to leak up into the esophagus. Once people start losing a significant amount of weight after gastric bypass, they tend to find that the acid reflux improves. Therefore, it is important to maintain your weight loss so that you keep reflux at bay.

Manage stress.

Acid reflux is associated with psychosocial distress, so try to limit triggers that cause stress in your life. For example, lightening your calendar and decreasing your to-do list can create more space for self-care like preparing healthier meals, exercising, meditating, doing hobbies, and socializing.

Don't overdo at the table.

Certain foods can irritate your digestive system. For example, spicy and greasy foods often cause indigestion. Avoid these foods as best you can so that you do not experience reflux. Similarly, the less you eat at one time, the better--especially after gastric bypass surgery. Because your stomach size has been reduced to hold only one ounce of volume at one time, any additional food will surely apply pressure on your LES. People who overeat after gastric bypass surgery are at risk for acid reflux and other unpleasant symptoms like dumping syndrome.

Say no to alcohol.

Alcohol consumption after gastric bypass surgery can be dangerous. Because your digestive tract is shorter, alcohol can enter your bloodstream more rapidly and make you feel intoxicated more quickly. It is also packed with poor calories and can negatively affect your blood sugar, especially if you have diabetes. Furthermore, alcohol also increases your risk of acid reflux and causes damage to your esophageal tissue.

Manage other health conditions.

Many people who are severely overweight seek gastric bypass surgery for acid reflux treatment and other health conditions like type 2 diabetes. Because other health conditions usually accompany obesity, you must receive regular care for your conditions to optimize your health. Acid reflux after gastric bypass can also be the result of other conditions causing stress in your body.

See your doctor. Your doctor may recommend trying an antacid medication if lifestyle modifications do not improve reflux after gastric bypass. If a trial of an antacid does not offer relief, you may need to have an upper endoscopy procedure. A specialized doctor takes a small camera to look down into your esophagus and stomach. With this test, your doctor will assess if you have any lesions, protruding veins, or a weakened LES.

Acid reflux after gastric bypass often resolves with weight loss. However, it is important to tell your doctor if you are experiencing this painful symptom after losing excess weight.