GERD After Bypass Surgery: Causes, Complications, Treatment

Gastric bypass, or the Roux-en-Y gastric bypass (RYGB), is a type of bariatric or weight loss surgery. This is done to promote weight loss and manage obesity.

Obesity increases your risk of gastro-oesophageal reflux disease (GERD). GERD causes acid reflux, which happens when the contents of your stomach flow back into your esophagus.

In people with GERD, gastric bypass surgery can help. But sometimes it can make GERD worse.

Let us examine the relationship between GERD and gastric bypass and how it compares to other weight loss surgeries.

The lower esophageal sphincter (LES) is a muscle ring that occurs at the bottom of your esophagus. It connects your esophagus to your stomach.

Normally, the LES stays closed to protect your esophagus from the acidic contents of your stomach. When you eat, it opens to let food through.

But if the LES is weak or other factors are present, it can cause the contents to flow back into the esophagus. It can cause acid reflux, also called gastro-oesophageal reflux.

GERD occurs when acid reflux is chronic. You may be more likely to experience GERD if you are overweight or obese.

Gastric bypass surgery is the most common weight loss surgery. It involves dividing the abdomen into a small upper pouch and a large lower pouch. The small intestine is then divided and connected to both. This creates a “Y” shape.

The operation affects GERD because it changes the following factors:

  • press the LESSON
  • acid production
  • your esophageal reflux

According to a 2020 review of studies, gastric bypass appears to be the most effective surgery for GERD symptoms. It is therefore the most recommended weight loss surgery for people with severe GERD.

In a small 2020 study, researchers examined the prevalence of GERD after various weight loss surgeries. These included gastric bypass and laparoscopic sleeve-hole rectomy (LSG), or gastric sleeve surgery.

They found that GERD was more likely to affect people who received gastric bypass surgery compared to those who underwent gastric bypass.

Similarly, according to a 2017 comparative studygastric bypass surgery is associated with an increased need for GERD medication compared to gastric bypass.

A gastric bypass surgery can improve GERD in several ways:

  • reduction of acid production in the small upper sac
  • decreasing esophageal reflux (due to the “Y” shape of the rearranged organs)
  • reducing exposure to gastric acid in the esophagus
  • increases how quickly the contents in the top bag are emptied
  • promote weight loss
  • reduction of abdominal pressure on the LES (due to a smaller stomach and weight loss)

But gastric bypass may not resolve BUOO in everyone.

According to a 2014 review of studies, a 2002 study assessed changes in GERD symptoms following RYGB. Of 152 people who participated in the study, 64 percent reported significant improvement in GERD symptoms at 12-month follow-up.

According to the researchers, it could be due to the stomach sac being too large, causing constant acid production. In other cases, the rearranged organs can cause bile to flow backwards.

GERD can also be affected by other types of weight loss surgeries:

Sleeve gastrectomy

In a sleeve-hole rectomy, or gastric sleeve surgery, about 80 percent of the stomach is removed. This makes the size and shape of the stomach similar to that of a banana.

The surgery is simpler than other types of weight loss surgery. But it can cause or worsen GERD.

Like the studies above, a small 2020 study found that a tummy tuck is associated with GERD. A 2017 study also found that a stomach sleeve increases the need for GERD medication.

According to a 2021 survey, 84.1 percent of people with GERD still had it after a tummy tuck surgery. What’s more, 44 percent of people experience more acid reflux 18 months after the procedure.

A 2021 study also found that up to 40 percent of people who receive a tummy tuck develop GERD.

The higher rate of GERD after receiving a tummy tuck may be related to:

  • reduced LES pressure
  • reduced stomach volume
  • reduced gastric emptying
  • narrow shape of the abdomen

Adjustable tummy tuck (AGB)

An AGB, also called a tummy tuck or lap strap, is a silicone device that is placed around the upper abdomen. It makes the stomach smaller, which reduces the amount of food you can eat.

According to a 2020 reviewthe gastric band has mixed results with GERD.

The review indicates that GERD symptoms decreased after surgery from 33.7 percent to 7.7 percent. At the same time, 15 percent of the people studied developed GERD after surgery.

According to the researchers, the placement of the band can promote GERD symptoms by increasing pressure.

Treatment for acid reflux or GERD after gastric bypass involves the usual treatment for both conditions.

A doctor may recommend:

Lifestyle changes

Lifestyle changes are the key to treating GERD. These may include:

  • lose weight or maintain a moderate weight
  • lift your head on extra pillows during sleep
  • avoid meals at least 3 hours before bedtime
  • quit smoking if you smoke (this can be difficult, but a doctor can draw up a strike plan that works for you)
  • eat a balanced diet
  • restricting foods or beverages, such as carbonated beverages, that aggravate your GERD symptoms


The first-line medications for acid reflux and GERD are proton pump inhibitors. These drugs work by reducing acid production in your stomach.

A doctor may also recommend:

  • Antacids. Antacids neutralize the acid in your stomach.
  • H2 blockers. H2 blockers work by reducing acid production.
  • Prokinetic drugs. Prokinetic drugs strengthen the contractions of your LESS, as well as the muscles in your digestive tract.


If lifestyle changes and medications do not control your GERD, you may need surgery. These include gastric bypass (RYGB) as well as:

Fund application

Fund application involves the sewing of the upper abdomen around the bottom of your esophagus. This increases the pressure on the LES, which reduces acid reflux.

This procedure is the most common surgery for acid reflux and GERD.

LINX surgery

This operation involves a ring of metal beads. The beads are connected by a magnet.

The ring is implanted around your lower esophagus, where it closes the LES. This prevents the stomach contents from flowing back into the esophagus.

When you swallow, separate the beads so that food can pass through.

Strict procedures

This procedure involves an endoscope, or a flexible tube with a light and camera on one side, equipped with a tool that provides thermal energy. It radiates a radio frequency, which amplifies the LES.

Without treatment, GERD can lead to:

After a gastric bypass operation, it is important to follow up with a doctor. This will enable them to look at negative outcomes and ensure that you heal properly.

See a doctor if you notice new or worsening GERD symptoms, such as:

You should also seek medical help if you:

These symptoms may indicate negative outcomes associated with gastric bypass.

If you have GERD and need weight loss surgery, gastric bypass may be the best choice. This procedure can help relieve GERD by reducing acid production, abdominal pressure on the lower esophagus, and esophageal reflux.

Other weight loss surgeries, such as tummy tuck and tummy tuck surgery, can cause or worsen BUOO. However, the best option depends on your GERD symptoms and underlying medical conditions. A doctor can determine if gastric bypass is right for you.

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