On this page, we address the relationship between a person’s weight and their risk of reflux disease. We’ll explain the disease, symptoms, its causes, the risks associated with it in the overweight and obese population. Most importantly, we’ll indicate the benefits that treatment with weight loss surgery might bring.
Gastro-oesophageal reflux disease (GORD), more commonly known as heartburn or acid reflux, is a condition where the stomach refluxes back into the lower part of the oesophagus (gullet).
Almost everyone has experienced heartburn at some point, in fact, it’s one of the most prevalent chronic diseases in the world with 40% of adults reporting symptoms in any 6-12 month period. In most cases, it lasts only a day or two, but for some, acid reflux can become a chronic, debilitating feature of daily life.
Obesity as a Risk Factor
When a person is overweight or obese their chances of having acid reflux increase significantly. Studies show that a person with a BMI between 30 and 35 is more than twice as likely to have reflux as someone with a BMI below 25. This risk factor increases further as BMI rises.
What Causes Acid Reflux?
At the lower end of the gullet, a ring of muscle called the lower oesophageal sphincter (LOS) normally acts as a valve to prevent acid contents of the stomach leaking (refluxing) into the lower part of the oesophagus. However, if the LES fails to function properly, stomach acid and bile juices can flow into the oesophagus, giving rise to heartburn and other symptoms of GORD.
Unlike stomach cells which secrete a special mucus to protect them from acid digestion, the lining of the oesophagus has no such protection and is therefore vulnerable to the effects of acid and bile salts. This can result in inflammation and – if prolonged – ulceration and bleeding.
It is not known why the LES fails to work properly, but we know that GORD is more common in males, during pregnancy, smokers, heavy drinkers and in those who are obese. In addition, if you have a hiatus hernia (when part of the stomach protrudes through the diaphragm), you have an increased chance of developing reflux disease.
We don’t know for sure why the prevalence of reflux disease is higher in the obese population but it has been speculated that it may have something to do with weight around the abdomen exerting pressure on the stomach and causing stomach contents to ‘reflux’ up into the oesophagus. This would explain why people experience worse symptoms when in bed at night.
LOS functioning properly
Acts as a barrier, preventing stomach acids from entering the oesophagus. No acid reflux symptoms
What Causes Acid Reflux?
At the lower end of the gullet, a ring of muscle called the lower oesophageal sphincter (LOS) normally acts as a valve to prevent acid contents of the stomach leaking (refluxing) into the lower part of the oesophagus. However, if the LES fails to function properly, stomach acid and bile juices can flow into the oesophagus, giving rise to heartburn and other symptoms of GORD.
Unlike stomach cells which secrete a special mucus to protect them from acid digestion, the lining of the oesophagus has no such protection and is therefore vulnerable to the effects of acid and bile salts. This can result in inflammation and – if prolonged – ulceration and bleeding.
It is not known why the LES fails to work properly, but we know that GORD is more common in males, during pregnancy, smokers, heavy drinkers and in those who are obese. In addition, if you have a hiatus hernia (when part of the stomach protrudes through the diaphragm), you have an increased chance of developing reflux disease.
We don’t know for sure why the prevalence of reflux disease is higher in the obese population but it has been speculated that it may have something to do with weight around the abdomen exerting pressure on the stomach and causing stomach contents to ‘reflux’ up into the oesophagus. This would explain why people experience worse symptoms when in bed at night.
LOS is weak
Fails to prevent stomach acid from flowing up into the oesophagus, causing the burning irritation symptoms of acid reflux.
Implications of Prolonged Acid Reflux
- Oesophagitis/ulcer – Inflammation and ulceration of the oesophagus may occur if reflux persists.
- Reduced quality of life – Patients may have to adapt their way of life to manage symptoms, for example by sleeping in an upright position. Over a prolonged period, it can also cause significant damage to the teeth.
- Anaemia – May occur due to loss of blood from the inflamed oesophagus.
- Oesophageal stricture – Scarring and narrowing of the oesophagus may occur, leading to difficulty swallowing.
- Barrett’s oesophagus – Patients with longstanding GORD are at increased risk of developing Barrett’s oesophagus which can, in turn, lead to cancer of the oesophagus.
Weight Loss Surgery as a Treatment Option
If you have been diagnosed with reflux disease, you are taking medication for it and you have a BMI above 30, then weight loss surgery is a very effective treatment, both for your reflux and to return you to a healthy weight.
The best weight loss surgery procedure for those with reflux is the Roux-en-Y gastric bypass. This is not only the best procedure for treating reflux but also a range of other health issues associated with obesity, e.g. Type 2 diabetes and high blood pressure, etc.
Usually, we would only do bypass surgery in a patient with a BMI above 35. If you have a BMI in the range of 30-35 it is possible we could consider a gastric band procedure to treat your reflux and your weight. The evidence on the gastric band as an effective treatment for reflux is mixed. Generally, we favour the argument that the band is an effective anti-reflux procedure but only when the band is correctly adjusted and the patient is following the recommended diet closely.
Two procedures that patients with reflux disease should certainly not have are the gastric sleeve and mini gastric bypass. These are effective treatments for obesity but both are shown in studies to increase reflux symptoms post-operatively.
"Reflux symptoms are very common in the obese patients I see in clinic, and a high proportion is being treated with PPIs. The good news is that gastric bypass is a very effective treatment for those who are eligible and I expect all of my bypass patients to be off of their PPI medication within 3 months of surgery."
Acid Reflux Treatment
Treatment for people who suffer from acid reflux / GORD varies depending on the severity and symptoms of their disease. Mild or occasional heartburn usually responds well to lifestyle modifications such as losing weight, stopping smoking and changes in dietary habits. However, if you have moderate to severe GORD, lifestyle changes alone may not be sufficient and your doctor may prescribe a course of anti-reflux medication.