GERD After Revision to Bypass and Linx

[chasingpolaris321 214]

Hi everyone, I had my sleeve surgery in 2014, and revised to bypass in 2017 because of severe GERD. Before my revision, I was vomiting up food and had horrible reflux, and the revision did help some with my symptoms. I have been on a PPI since my revision, and for the last couple of years my GERD has gotten a lot worse and I am dealing with a lot of burning and gagging at night on acid despite being on 40mg of omeprazole and pepcid twice a day. I have a consult with a doctor in early October to talk about the Linx surgery as a possible option, and I was wondering if anyone has experienced something similar or contemplated the Linx after having a revision to bypass. I can’t find any information about bypass patients having Linx online, and obviously having another surgery makes me nervous and is not ideal. I am tired of the contact burning and need to be on so many medications, but I know Linx can have side effects and I am just trying to weigh my options. Thanks so much!

[catwoman7 10,846]

Wow - sorry to hear you are dealing with this. Bypass usually cures (or greatly improves) GERD, so I'm so sorry it didn't do the trick for you. I've heard of Linx but don't know that much about it - but anything that helps with the GERD is probably not a bad idea. That can evolve in Barrett's esophagus (which in turn can evolve into esophagus cancer) if unmanaged - so I'd be inclined to do whatever they recommend. Again, I'm so sorry you're dealing with this!!

[chasingpolaris321 214]

Thanks! Yeah it has been pretty exasperating. I will see how the consult goes in October, and then hopefully that will give me a better idea of what options I have. GERD can be so miserable!

[liveaboard15 1,292]

had no idea you could get GERD after bypass. That was the whole point of doing that. as for the linx i was looking into that a couple months ago. Its interesting but also very odd lol. I checked out how much that would cost (I am self pay) and i think the surgery for that was like 14K.

[chasingpolaris321 214]

35 minutes ago, liveaboard15 said:

had no idea you could get GERD after bypass. That was the whole point of doing that. as for the linx i was looking into that a couple months ago. Its interesting but also very odd lol. I checked out how much that would cost (I am self pay) and i think the surgery for that was like 14K.

I was definitely not told when I had my revision from sleeve to bypass that there was a chance I would still have GERD. I’m sure it’s not super common, but it has been a huge struggle and I hate the idea of being on a high dose of PPIs for the rest of my life that don’t even control it well. I’m also a bit nervous about the insurance issue. I don’t know if the Linx will be covered or not and it would suck to have to pay a ton out of pocket for it.

[catwoman7 10,846]

1 hour ago, liveaboard15 said:

had no idea you could get GERD after bypass. That was the whole point of doing that. as for the linx i was looking into that a couple months ago. Its interesting but also very odd lol. I checked out how much that would cost (I am self pay) and i think the surgery for that was like 14K.

it's pretty uncommon. Bypass usually cures (if not greatly improves) it.

[RickM 1,747]

When you have an unusual situation such as you have, I have found it useful to get second and even third opinions. A general or general GI surgeon may not have that much experience with bariatric patients, and a strict bariatric surgeon may not have run into this type of problem before (though is more likely to be familiar with such complications. Is this a problem with something that's odd about you, or was there something odd about the way the bypass revision was done - good to get a fresh set of bariatric eyes on that to check. Is it a hiatal hernia - some bariatric surgeons have a hard time dealing with them, (and some don't...) and likewise some general surgeons may have a hard time dealing with that in a bariatric patient.

A regional cancer center with a GI department can be a good place to consult, as they tend to have experience with a broader set of unusual cases, and they also usually have an associated bariatric department. I ran into an odd cancer situation a few years ago (thankfully fairly minor and early), such that even a major center might see one or two per year, and was a subject of one of the department's monthly meeting where the doctors all get together and discuss their "interesting" patients and brainstorm different approaches to the problem. You may need that level of "interest" to solve your problem hopefully not,) but it's good to be able to tap into that level of resource if it's needed.

Good luck in finding a solution...

[Tomo 1,135]

6 hours ago, chasingpolaris321 said:

Hi everyone, I had my sleeve surgery in 2014, and revised to bypass in 2017 because of severe GERD. Before my revision, I was vomiting up food and had horrible reflux, and the revision did help some with my symptoms. I have been on a PPI since my revision, and for the last couple of years my GERD has gotten a lot worse and I am dealing with a lot of burning and gagging at night on acid despite being on 40mg of omeprazole and pepcid twice a day. I have a consult with a doctor in early October to talk about the Linx surgery as a possible option, and I was wondering if anyone has experienced something similar or contemplated the Linx after having a revision to bypass. I can’t find any information about bypass patients having Linx online, and obviously having another surgery makes me nervous and is not ideal. I am tired of the contact burning and need to be on so many medications, but I know Linx can have side effects and I am just trying to weigh my options. Thanks so much!

From what I understand, a couple reasons why some have gerd after bypass (although extremely rare) is because their surgeons made the roux limb too short or that your LES isn't functioning properly and letting your stomach contents back into your esophagus . Perhaps you can have speak to your doctor (or see a second opinion). I sure hope you get it resolved.

[chasingpolaris321 214]

Thanks everyone! The consult I have is with a surgeon who does bariatric surgery as well as the Linx procedure so I’m hoping with his joint experience he will have some insight. I appreciate the advice and will ask him about the LES and roux limb possible issues. Thanks again!

[Tracyringo 503]

I have the same issue over 2 years after my revision to RNY. The GERD has never left and i am still on the strongest PPI twice a day and I still Burn at times ! Please let me know if you are able to get help. The Dexilant is over $2500 every 3 months !!! My saving grace is that my insurance covers it!

[Tomo 1,135]

I have the same issue over 2 years after my revision to RNY. The GERD has never left and i am still on the strongest PPI twice a day and I still Burn at times ! Please let me know if you are able to get help. The Dexilant is over $2500 every 3 months !!! My saving grace is that my insurance covers it!

I had read that that if one still has gerd after rny, it is due to a too short roux limb and get get it lengthen. When I had my revision, my surgeon discussed how important it was to have a longer roux limb in the cases.

[chasingpolaris321 214]

Just a quick update, my endoscopy showed that I had a significant amount of bile reflux. I haven’t had my follow up appointment with him yet to talk more about it, but it sounds like bile reflux can happen when you have bypass and also when you have your gallbladder removed, so that might be what’s going on. I also have a hernia that needs to be repaired. I’ll post an update once I gave my follow-up with the doctor in early November.

[Tracyringo 503]

1 hour ago, chasingpolaris321 said:

Just a quick update, my endoscopy showed that I had a significant amount of bile reflux. I haven’t had my follow up appointment with him yet to talk more about it, but it sounds like bile reflux can happen when you have bypass and also when you have your gallbladder removed, so that might be what’s going on. I also have a hernia that needs to be repaired. I’ll post an update once I gave my follow-up with the doctor in early November.

Bile reflux what is difference? It should still go down and not burn right? Did you ask about the limb being too short? Very interested to see if they are able to help.

[chasingpolaris321 214]

From reading online, it sounds like bile comes from the liver and not acid in the stomach, so PPIs aren’t as effective at treating it and lifestyle and diet changes don’t really help as much. I actually just messaged my doctor to ask about the short roux limb as a possible cause, and will let you know what he says when he gets back to me. There is definitely some research online showing that that can be the cause, and that there’s a possible option of lengthening the roux limb as a way to resolve it. I don’t know enough about anatomy to know if that would be an option for me because my gastric bypass happened after I originally had sleeve surgery so I’m not sure if anatomically the lengthening would work. I’ll for sure report back once I learn more!