Gastritis is a general term used for the description of symptoms associated with several very different physical conditions and require different treatments based on their ideology . Gastritis, gastroesophageal reflux, and bile reflux gastritis

Gastritis may be caused by excess acid or bile in the stomach. Some patients may have gastroesophageal reflux due to a hiatal hernia, which needs to be treated surgically with Nissen fundoplication, regardless of the size of the hernia, contrary to what gastroenterologists recommend by prescribing antacids for an extended period. I have seen patients who have had one cm hiatal hernia and have been very symptomatic, and others who have had larger hiatal hernias and have been asymptomatic. Size should not be a determinant of whether the patient has had or will have a hernia repair or not.

 

 

Billiary Diversion is the definitive surgical procedure for Bile Reflux Gastritis.

One of the leading reasons for Gastro-esophageal reflux disease (GERD) is a physical defect called a Hiatal hernia. The esophageal Hiatus is the opening in the diaphragm where the esophagus enters from chest cavity allowing the esophagus to pass into the abdominal space. If the opening in the diaphragm is much larger than the esophagus, it will result in reflux of the stomach secretions and food from the stomach into esophagus. *Note: Graphic surgical pictures below

Hiatal Hernia Causes:

• heavy lifting
• coughing
• obesity
• injury
• persistent vomiting
• age related

Reflux and Hernia Symptoms:

• sour taste
• reflux
• heartburn
• belching
• chest or abdominal pain
• difficulty swallowing
• vomiting
• no symptoms

The treatment includes dietary changes, medication and in those who do not improve surgery.

Hiatal hernia repair includes tightening of the dilated opening of the esophageal hiatus by re-appoximating the separated muscle fibers of the right and the left crus. This tightens the defect in the diaphragm and helps prevent part of the stomach or stomach contents from entering the chest cavity.

You can find further information and dietary changes regarding Hiatal Hernia and GERD here, including information unique to weight loss surgery and Hiatal Hernia. You can also find further surgical information, as well as a surgical video here.

A recent study Published in JAMA Surgery,  quoted rate of 10-20% of patients who have had anti-reflux surgical procedures will have recurrence of his symptoms  within the research data.  There are numerous studies that  have identified predictive factors leading to  return of the symptoms after surgical intervention. Some of these predictive factors are improper diagnosis, inadequate work up and technical issues.

Due to the significant rise of sleeve gastrectomy as well as a high failure rate of the lap band, we have seen several patients presenting with significant reflux disease after weight loss surgery.  There is a little scientific data regarding the failure of anti-reflux procedures in patients who have had previous weight loss surgical operations. In our practice, however,  we have  extensive experience with anti-reflux operations in patient who have had previous weight loss surgeries including Gastric Bypass,  Adjustable Gastric Banding, Sleeve Gastrectomy and Duodenal Switch operation.

Improper diagnosis, inadequate work up, and technical issues have been cited as possible causes for recurrence of symptoms in patients  who have not had weight loss surgery. One could assume that those variables are still a factor in addition to other factors resulting from a previous weight loss surgery. The complications of a previous weight loss surgery can not be under-estimated; an example would be a patient with significant esophageal motility issues directly related to an Adjustable Gastric Band. Other situations that exacerbate symptoms of reflux are an hour glass shaped sleeve or a stricture mid stomach post Sleeve Gastrectomy or Duodenal Switch.

In our experience, some patients have responded well with anti-reflux surgical procedures and mesh placement if indicated after a compete work up with has included and upper endoscopy, upper GI series, manometry and Ph studies.  Any patient with symptoms of reflux after weight loss surgery, should be evaluated, and a complete work up should be performed to  establish the proper treatment options. It is not wise to have patients be treated with proton pump inhibitors as a default treatment without a complete work up for any patient with reflux. These class of medications have significant side effects associated with them. Furthermore, prolonged reflux is a factor in development of Barret’s Esophagus, a pre-cancerous condition.