It is not uncommon to experience occasional acid reflux and see heartburn as a side effect, but if the reflux becomes more frequent, with increased severity and you are waking up in the night because of it, a diagnosis of Gastroesophageal Reflux Disease (GERD) may then be considered. The Academy of Nutrition and Dietetics defines GERD as, “a digestive disorder in which stomach acids, food and fluids flow back into the esophagus. It can occur at any age and may be temporary or a long-term issue. The danger of untreated GERD is that it can cause health problems such as inflammation of the esophagus, which is a risk for esophageal cancer .” There are lifestyle changes that can be taken in order to decrease the occurrence of acid reflux without turning to medication which may include quitting smoking, weight loss, wearing loose fitting clothing, avoiding laying down directly after eating, and sleeping with the head of the bed elevated .
Obesity has been linked with an increased diagnosis of GERD. It has been shown that individuals with a BMI above 30 are 2.5 times more likely to have acid reflux than people with a lower BMI . It is common for an individual who qualifies for a bariatric procedure to have acid reflux before surgery. Weight loss is a major factor that can relieve reflux symptoms, but depending on the bariatric procedure performed, reflux symptoms may continue or worsen. It is important to have ongoing contact with your bariatric surgeon and/or healthcare provider to ensure you are receiving the proper treatment for possible deficiencies and further health concerns. The following tips are common ways to treat acid reflux and heartburn after bariatric surgery.
1. Diet Therapy
An acid reflux flare-up can be avoided by knowing what and when to eat. There are certain foods and beverages that are likely to worsen reflux symptoms. Flare-ups may be triggered by foods like chocolate, citrus, mint, acidic foods, spicy foods, and fatty foods. Many people find relief when choosing lean meats and proteins (poultry, fish, tofu, beans, etc.), limiting high fat (butter, fried foods, pastries, etc.), consuming baked options instead of fried, and choosing complex carbohydrates (whole grains, vegetables, etc.). Symptoms may also be alleviated when eating smaller, more frequent meals and avoiding overeating. Overeating can cause stomach discomfort for bariatric patients as well as an increased possibility of acid reflux. The time of day you are consuming food is also very important. It is not recommended to eat late at night because it can increase gastric acid production and laying down right after may result in heartburn. Rule of thumb, try not to lay down for at least 1 hour after eating.
Certain beverages can also trigger an acid reflux flare-up. It is recommended to avoid alcohol, carbonated drinks, and caffeine. These beverages can reduce the function of the lower esophageal sphincter. When function is reduced, the sphincter relaxes and can open when the mechanism is supposed to be closed allowing acid and stomach contents to travel back up the esophagus .
The diet treatment for GERD is quite similar to the lifestyle change you should be following after bariatric surgery (avoid alcohol, carbonated beverages, eat smaller portions, choose healthier options, etc.). It can be helpful to keep a food log if you find that certain foods cause a flare-up. This is important when trying to control acid reflux or GERD because it can track patterns and be shown to your healthcare provider or registered dietitian in order to offer you proper guidance.
2. Weight Loss
Obesity has been associated with a lack of esophageal sphincter function possibly due to the excess weight increasing pressure on the abdomen and pushing stomach contents up towards the esophagus, leading to an increase in GERD and acid reflux cases . Weight loss and lifestyle change have been shown to alleviate symptoms . Those who have GERD or acid reflux before bariatric surgery are more likely to be recommended Roux-en-Y gastric bypass because it has been an effective method in decreasing GERD symptoms . Sleeve Gastrectomy and other restrictive procedures have been found to provoke reflux symptoms, especially if you had acid reflux prior to bariatric surgery . If you continue to have GERD after weight loss surgery, it is important to speak with your bariatric surgeon. Acid reflux and GERD can affect quality of life and prevent you from reaching your full weight loss potential after surgery due to diet compliance.
Your bariatric surgeon will want to look into acid reflux problems to rule out stomach complications that may need repair. There are different procedure options that may be considered if weight loss, diet change, and medication does not help. Individuals with severe GERD after restrictive procedures, like a sleeve gastrectomy, could be considered for a second bariatric procedure to convert the sleeve to gastric bypass . There are other complications to rule out as well that may be causing the reflux, like a hiatal hernia or twisted sleeve. Surgical decisions are never taken lightly, and much thought will be put into the process.
If all other options have been pursued and there is still no change in acid reflux flare-ups, then medication could be another option. Your healthcare provider may recommend taking an antacid (TUMS), a proton pump inhibitor (omeprazole, esomeprazole, etc.), or an H-2-receptor blocker (cimetidine and famotidine). It is important to know that chronic reflux, like GERD, will not get better on its own and will need some sort of treatment prescribed by your healthcare provider.
Medications used to treat GERD and heartburn symptoms work by suppressing stomach acid. Decreased stomach acid can modify the bioavailability and absorption of vitamin B12, vitamin C, calcium, iron and magnesium . With that being said, it is also well known that bariatric procedures result in a risk of vitamin and mineral deficiencies due to restriction and malabsorption. There are many factors that can increase your risk of deficiency and that is why it will always be important to stay compliant with your bariatric specific multivitamin regimen for life. A higher risk of deficiency does not mean that you should stop taking heartburn medication if you have had bariatric surgery. It means that staying in contact with your healthcare provider is essential to reassess your individual needs.
If you have the occasional heartburn as a result of acid reflux, it is unlikely that you will need medication on a daily basis to treat the problem. Although, a change in diet or weight loss may still be necessary to keep the issue controlled. Any health concerns should still be discussed with your healthcare provider so that treatment can be tailored to your needs and monitored.
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 Moran-Atkin, E. (2017). GERD and Bariatric Surgery. Retrieved June 25, 2020, from https://www.obesityaction.org/community/article-library/gerd-and-bariatric-surgery/
 El-Hadi, M., Birch, D., Gill, R., & Karmali, S. (2014). The effect of bariatric surgery on gastroesophageal reflux disease. Canadian Journal of Surgery, 57(2), 139-144. doi:10.1503/cjs.030612
 Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: Why we feel the burn. Journal of Thoracic Disease, 11(S12). doi:10.21037/jtd.2019.06.42
 Heidelbaugh, J. J. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: Evidence and clinical implications. Therapeutic Advances in Drug Safety, 4(3), 125-133. doi:10.1177/2042098613482484