Revision for GERD to bypass- what was your process?

[MacEBE 0]

I was sleeved in 2017. In hindsight, bypass would have been better given my history of GERD. Fast forward years later, COVID piled the weight on (working from home, lockdown, job stress (worked in healthcare during pandemic) and I'm up 65 lbs. That i can deal with though. I know the bariatric lifestyle, and I know what I need to do to lose the weight healthily and such. It's the GERD. I'm up to 60-80 mgs of Prilosec daily, plus antacids and other H2 blockers as needed. I sleep elevated and just always generally feel like I have a pit in my sternum. I've subsequently relocated to a new state since my surgery, so I feel like I'm starting all over. I have an appointment with my PCC this week to discuss the GERD issue. Given what people are stating on this board, it seems like that a RNY may be an option. Honestly, I just want to know why it has escalated so bad over the last several years. It doesn't matter what it is; it comes up. I drank some unsweetened almond milk two hours after dinner, and about 10 mins later I literally burped it up like a baby. No warning, nothing... All over my bed. Other times, it's that hor burning awful acidic in my throat and chest. Makes me cough. I try to eat crackers to help absorb the acid, which is not healthy. I'm really quite scared that's something serious. What have your experiences been like? Will I go through a whole program again? I just want relief. What questions should I bring up with my doctor. What tests will they run? This is still a fairly new PCC relationship and several thousand miles away from where I first was treated/sleeved.

[RickM 1,747]

Possibly a hiatal hernia has developed, as GERD is a common symptom of that irrespective prior WLS history. An EGD (endoscopy) would establish that as well as anything else that is going on in there; possibly an imaging procedure like a barium swallow to look at shaping of the sleeve and associated connections can help to establish how things are flowing and why backups are happening. Your primary may order those things or refer you to a gastroenterologist to track down that problem, then they can start considering solutions - fix the hernia, resleeve to correct shaping problems or revise to an RNY.

[ChunkCat 675]

The pressure in our little sleeved tummies is different than the pressure in a regular tummy from the things I've read. This can cause reflux to happen. Plus the acid our stomach produce when larger is the same amount produced when smaller, so basically we have more acid than we need. There are better PPIs than Prilosec, have you tried Protonix or Dexilant? I have had much better luck with these.

RNY revision for reflux is a good option for a permanent solution. They'll probably do imaging to prove you have reflux (an upper GI series) and an endoscopy to check out the status of your stomach and esophagus. Insurance usually requires these before considering approval of a revision. I wish you much luck in finding a solution!!

[rhplus 1]

I was recently converted from a sleeve (6-10-2013) to a RNY (11-7-2023) because of GERD. Getting insurance to cover it took 8 months. 4 appeals. And Multiple calls and emails all the way up to the VP of the company. I work in medical education so I fought and fought and fought and finally proved they had an immense amount of bias towards obese individuals. They kept denying me because I "gained weight" and "just want to lose more weight" that I "don't have GERD". In that 8 months of proving I have GERD I had to have an EGD, Barium Swallow, Stress Test, Colonoscopy, and a PH Monitoring study (that was the really crazy one).... and they were positive for GERD. They kept insisting that no they weren't positive and if I just lost weight I wouldn't have heartburn. When I had my first sleeve I was 380 pounds I got down to 170 pounds in 2017. In 2022 when I started the program to get the revision I was 220. So yes I had gained some weight but NO I hadn't regained all my weight. My entire experience has been very eye-opening how quickly someone in insurance will deny obesity as a medical condition and say it is a lifestyle choice. Especially when the entire point of the conversion was to fix GERD and not lose weight! If you seek to have the revision my advice is keep all the framing on GERD. Don't even reference weight or weight loss. It has to be for GERD. Study that insurance companies weight loss surgery policy and reference it often. It is best practice to convert a sleeve to RNY to fix GERD. And craziness I had the conversion and haven't had GERD once since! Don't let them tell you no. If the tests prove you have GERD get the conversion.

[Keona1323 11]

I just had mini bypass revision from sleeve as I had severe GERD. Now I have bile reflux ☹️

[MacEBE 0]

Thanks for responses all. I spoke with my insurance and they told me it would fall under medical benefits and that they are seeing it ALOT with sleeve. I've gained some weight as well, but that it not my primary concern here. I am having a barium swallow, EKG, endoscopy, and a few others tests. We shall see. It would be interesting to see the different insurance we all have. I have UHC.

[QMLOHD 8]

any updates on this? I had the sleeve October of 2020 and my Gerd has been bad the whole time taking PPI's. I am trying to get a revision to RNY. just got a denial for my appeal from UHC (United Healthcare) who says my Esophagitis is only Grade A and they won't approve unless it is a grade C or D. I want to appeal again but I don't think it will work. Now I am considering paying cash for the procedure but I was told if I did and there were complications later in life there would be no coverage. HELP. Any information would help. Thank you