In our series of acid reflux we need to talk about gastric bypass, the gold standard of the weight loss surgery, and basically the surgery that will help you if you have reflux with any other surgery.

But, what happens if you already have a bypass and you have acid reflux?

Well, we need to review the stoma of the surgery. Sometimes when your pouch creates a lot of acid, or your stoma is very very tight, the food can sit  and burn and you can get ulcers, what we call, marginal ulcers.

The most important test in this case will be an endoscopy. The endoscopy will serve as a test and treatment for acid reflux. It will let us know if there are any ulcers or if you have any strictures, and we can also perform a dilation of the stoma.

We advise never to dilate more than 12 millimeters. It’s better to do two or three procedures until you have the proper 12mm instead of going with the full 20 with a balloon dilation because you can lose that restriction; you may not have reflux anymore, but without restriction, you are prone to gain weight again. If in this case you have a stricture, there will be a lot of acid in the stomach.

What happens with a bypass patient? Sometimes vitamins that are needed for your daily life can burn the little pouch, so we advice to take liquid vitamins and don’t take all the vitamins at once, do not take them on an empty stomach, try to have different kinds of presentations, choose the vitamins that suit your stomach best and don’t give you acid reflux.

If you have a lot of acid reflux, we need to review the size or length of your limbs, because if they are too small or short, we need to give you a little bit of more malabsorption so you don’t have biliary juices flowing back to your stomach.

If you have acid reflux, we advice to first change your eating habits. Review what you’re doing wrong: if you are drinking too much coffee, if you are drinking alcohol, smoking… And if when you withdraw of all that you still have acid reflux, we need to test and we need to check what is going wrong.