Acid Reflux Risk
On this week’s episode of Bariatric Friday, Kemal Erkan and Dr. Donovan Hui sit down to talk about acid reflux and its associated risks. Around 20% of American adults suffer from reflux, and some may not even be aware what it is. Acid reflux is a condition in which stomach acid flows backward into the esophagus, causing irritation, discomfort, and a burning sensation known as heartburn. It occurs when the lower esophageal sphincter (LES) muscle weakens or fails to close properly. Frequent, chronic acid reflux is known as GERD. This can occur for a number of reasons. Those with obesity tend to be predisposed for GERD due to cytokine inflammatory changes, as well as excess intra-abdominal pressure from excess adipose tissue in the belly.
The reason why it is not ideal for stomach acid to go up to the food pipe is first, due to the painful, burning sensation that the patient experiences. While called heartburn, the condition does not actually affect the heart. However, discomfort in the chest region can be hard to distinguish from actual cardiac events, which can pose a hazard to health. Additionally, the lining of the esophagus is different from the lining of the stomach. The lining of the esophagus is not built to interact with the degree of acidity that is present in the stomach. Barrett’s esophagus is a condition in which the lining of the esophagus changes to match that of stomach, which is precancerous.
Erkan then asks the question, when does this issue become serious enough to consult a surgeon? Most of the time, patients who have reflux are treated with a course of antiacids such as omeprazole or pantoprazole. These medications are called proton pump inhibitors, which are meant to reduce the production of stomach acid. Other symptoms that might signal concern are hoarseness, a cough, and a sour taste in the mouth. These are signs that acid is not just going into the esophagus, but all the way up into the throat.
Because obesity is a big predisposing factor to developing GERD, bariatric surgery can be a helpful tool to address this condition. For patients undergoing sleeves, there actually can be a higher risk of reflux due to increased pressure. The type of surgery chosen matters when it comes to tackling the patient’s individual conditions. For those with significant esophagus conditions or a hiatal hernia, surgeons would offer a gastric bypass instead, Dr. Hui says. However, there are also a subset of patients who have functional dyspepsia, or a hypersensitivity to what goes through their esophagus. This may present as acid reflux symptoms without the actual acid present in the esophagus.
For those that experience reflux after surgery, the condition will be monitored based on where the patient is in their weight loss journey. As needed, the reflux will be treated with PPIs to make sure the patient is comfortable. The surgeon will also perform a repeat endoscopy to see if there are any anatomical issues contributing to symptoms of reflux. If there are significant issues, the surgeon may go the route of conversion to a gastric bypass.