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Why do you treat heartburn after gastric bypass surgery?

Why do you treat heartburn after gastric bypass surgery?

Perhaps you or someone you know has gotten gastric bypass surgery - the surgical procedure for weight loss. You want to reap the benefits of the pounds that you will lose, but you are experiencing sharp pain in the stomach area, and you feel like the acid in your stomach is burning your insides in the chest area.

Your weight loss journey could be accompanied by some hurdles, like heartburn.

Anatomy after gastric bypass surgery

To know what is going on, let’s take a look at what bypass surgery is and what results from the surgical procedure. The surgeon cuts through the stomach and makes two pouches of the stomach, one smaller and one larger. The smaller one is then connected to the small intestines. In this way you can lose weight fast because the contents in the stomach have been drastically reduced because the volume of the stomach has been reduced.

The problem is that the stomach still can produce those gastric acids, namely hydrochloric acid. The small volume resulting from the surgery makes it so that those acids are more prominent in the smaller volume of the stomach. And the smaller volume of the stomach means the acid can more easily overflow to the esophagus, and the esophagus area is where the burn really is.

The esophagus is the long muscular tube about eight inches long connecting your throat to your stomach. Even though it is called heartburn, the heart is not really affected. It is the lower esophageal area that is affected by the acid and this is what causes that sharp burning pain in the lower chest area.

This is in addition to the fact that you are not used to eating with such a small stomach. Your appetite needs to adjust to the smaller stomach volume. So, when you do eat regularly after the gastric bypass surgery, then you tend to overeat and overfill the small pouch of the stomach that was reconstructed. Before you know it the acid is overflowing to your lower esophagus and causing pain.

What is GERD?

The condition for chronic heartburn is known as gastroesophageal reflux disease, or GERD. In most people that have GERD, especially those who have not gotten a gastric bypass surgery, their stomach acids tend to just jump up to the lower esophagus from the stomach area. It may do so for several reasons. One is that the valve that is between the stomach and esophagus, called the esophageal sphincter, may become weak and grow more relaxed that what it should be. This causes the reflux or backup of acid from the stomach to the esophagus, thereby causing the pain of heartburn.

GERD is also more common in overweight people with a higher BMI. Even before your gastric bypass, you may have experienced heartburn. In some cases, the gastric bypass may even relieve the symptoms of GERD for those patients because the weight loss itself reduces the risk for GERD. Still, there are others that experience heartburn even worse than before especially right after getting the surgery. And if you are reading this then you may be one of those that have undergone the surgery and you may be experiencing the heartburn even more than before.

Pain in the stomach area may be indicative of heartburn.

How is heartburn after gastric bypass treated?

Now you know a little more of the basics of the physiology and anatomy of heartburn and gastric bypass surgery. You are thinking that is great, but how do you treat it? GERD is different than your occasional heartburn and treating GERD requires medical attention. This is when you must be in contact with your doctor because they will make a plan of action either through medication or surgery if the GERD is serious enough. But if they find that the heartburn will subside then there is no other plan of action other than to monitor it and control the pain.

The doctor may prescribe medications to control the output of the acid in your stomach such as drugs called proton pump inhibitors or PPI. These kinds of medication treat symptoms by using mostly the same treatment methods for heartburn or GERD patients that do not have gastric bypass. Antacids like Pepcid may also be suggested by your doctor to neutralize the acid that is already present in your stomach and esophagus.

In more extreme cases, surgery may be needed to fix the issue. There may be a hiatal hernia or stricture  causing the heartburn which need to be fixed with surgery. It is risky to have a second surgery after having your gastric bypass surgery, so it is important to talk to your doctor about the risks and benefits of moving forward.

To help the stomach reduce the concentration of the acids in the stomach it is also good advice to stay clear of foods and drink that are high in acidity like tomatoes, onions, or alcohol, or fruits. These acidic foods tend to make the acidity stronger in the stomach and cause more pain in the esophagus when acid does backup from the stomach.

Other natural methods include eating at a much slower pace and to keep reminding yourself that you have a smaller stomach because you got the gastric bypass surgery. You need to adjust to your smaller stomach, and you need to give yourself time to condition yourself to eating slower and in smaller portions, so your stomach does not overfill.


The ultimate takeaway really is that you should consult with your doctor if heartburn persists and is affecting your quality of life, then you and your doctor can make a plan to dealing with GERD after the gastric bypass surgery. There is relief from the pain, and it is a common complication after this kind of surgical procedure.

Hopefully reading this article has given you a much better picture of the basic mechanics of how gastric bypass surgery may cause heartburn after the procedure. The next time you have a visit with your doctor, you will be equipped with knowledge to better move forward with the right type of plan for you.

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Mark Aquino, RN, BSN, MHA.


Mark graduated from West Coast University. He has 3 years of experience as an RN in mental health and home health. He helps people live healthy and peaceful lives and owns a stress relief website.

Gintas Antanavicius, MD, FACS, FASMBS

Medical Reviewer

Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.