Bile Reflux after Mini Gastric Bypass Revision to Roux-en-Y Gastric Bypass

Lisa from Cypress, TX asked us this question:

“I had a mini gastric bypass over ten years ago and suffered from ulcers, bile and acid reflux, hiatal hernia and malnutrition so I had an RNY revision and hernia repair in June 2018. For six weeks I was GERD free, now I have it all back with a vengeance, it is burning my esophagus and throat and is here 24/7 with no real symptoms of reflux except the burning. It happens whether I eat, drink or don’t, but feels better when I do for the time I am ingesting. I also have Barrett’s esophagus mild, one cm at bottom of esophagus, but I feel like this is really damaging it further and all the way up the esophagus. I wonder if my operation to RNY was not completely done correctly? I had an upper GI to see what was going on and it says no evidence of hernia and mild upper reflux in the esophagus. Can you help? No PPI’s are working they don’t even make the pain a little less”

Dear Lisa,

Mini gastric bypass is associated with bile reflux and ulceration and revision to Roux-en-Y gastric bypass is the right solution. Hiatal hernia repair is also indicated to protect against esophageal gastric content reflux and help promote Barrett’s esophagus healing as well as prevent Barrett’s esophagus progression to cancer. Acid and bile reflux surgery when properly performed in the form of hiatal hernia repair and gastric bypass is very effective in stopping reflux. The surgery, however, has to be flawlessly executed to work. The distal esophagus must be properly dissected and mobilized to reduce the hiatal hernia. The Roux limb must be of sufficient length to prevent bile reflux. The jejuno-jejunostomy must be wide enough to prevent bile flow obstruction… Assuming all of these steps were taken into consideration, acid and bile reflux are not likely to occur. I definitely agree with you that an upper GI in addition to upper endoscopy and pH impedance study are needed to rule in or rule out acid or bile reflux. The sensation of burning in the throat and esophagus is indicative of acid or bile reflux but not enough to confirm GERD. A comprehensive and reliable work-up by a reflux specialist is required in your case.