Acid reflux and Heartburn after Gastric Bypass Surgery

Suzie from Houston sent us this question: “I had gastric bypass surgery in 2009. I suddenly developed acid reflux this year. I had an endoscopy that came back clear. I am on 80mg of pantoprazole and have changed my diet. I still have acid coming up – not every night but an average of twice a week. It is now happened at 4 AM. I’m sleeping in a recliner which doesn’t seem to help when it decides to come up. I take a lidocaine cocktail when it happens to help me with the aftermath of reflux. What else can I do?”

Dear Suzie,

The first step in acid reflux and heartburn management is good diagnosis. Upper endoscopy must be performed by a reflux specialist to check for obvious and subtle signs of acid reflux. In addition to upper endoscopy ambulatory pH testing and/or impedance testing are crucial to further demonstrate and quantify the severity of acid reflux. Additional testing in the form of contrast studies to elucidate the anatomy of gastric bypass are particularly helpful in your case. An upper gastrointestinal contrast study may demonstrate a fistula (connection) between gastric pouch and remnant stomach leading to severe acid reflux. A Ct scan may show internal hernia and/or partial bowel obstruction leading to bile back up into the Roux limb and gastric pouch. Bile reflux can cause severe heartburn similar to acid reflux.

The fact that you partially responded to high dose pantoprazole points towards acid reflux. However, additional workup is needed to confirm and stage the diagnosis of GERD. Treatment is subsequently tailored to your particular situation.