The Reflux and Obesity Connection:

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I'm Deborah Howell and today we'll be talking about the connection between obesity and GERD. Several factors contribute to developing or worsening GERD when the stomach increases in size. But happily, there are some answers for people with these conditions. Our guest today is Dr. Michael Russo, a general surgeon specializing in bariatric surgery with the MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center. Welcome Dr. Russo.

Michael Russo, MD: Thank you for having me. Great to be here.

Deborah Howell (Host): Our pleasure. What qualifies someone as being morbidly obese?

Michael Russo, MD: So obesity is determined by a index that's called the body mass index. And that's calculated and anyone at home can calculate this number. It's based on your height and your weight. Now when you calculate your BMI, which is your body mass index, if your body mass index is greater than 30, you're categorized as obese, and greater than 40, you're categorized as morbidly obese.

Deborah Howell (Host): Got it. Okay. 30 and then 40. What is GERD then and how does excess weight affect the symptoms of GERD one might experience?

Michael Russo, MD: So GERD or gastroesophageal reflux disease, which many people call reflux or heartburn, is essentially a dysfunction in the connection between your esophagus or food swallowing tube and the stomach. There is typically a one-way valve that's there that allows food and liquid to go down but prevents stomach acids from splashing up into the esophagus. This valve is controlled by some muscles that exert a pressure to keep it closed. Now people that have reflux disease either have a dysfunctional valve or they have excess pressure on the stomach side squeezing stomach acid to overcome the valve, or they may have both.

Deborah Howell (Host): You know you finally visualized, I really didn't get it before but that's such a clear picture now I can understand how an enlarged stomach would affect the esophagus. So how could a weight loss procedure resolve these symptoms?

Michael Russo, MD: Well, when someone is obese they carry excess weight in the stomach. Now what does that mean to them? That means more pressure being exerted on the stomach, possibly overcoming their normal valve mechanism that's at the lower esophageal sphincter, that tight ring. So if you get a weight loss procedure and lose a significant amount of weight, as long as you have a competent valve, many times actually reflux is resolved, not requiring any sort of medication and return to normal lifestyle, including the benefit of losing a significant amount of weight and improving a quality of life on that end.

Deborah Howell (Host): Wow. Well how effective - you've sort of spoke to this already but let's make it crystal clear - how effective is having a weight loss procedure in resolving the GERD symptoms?

Michael Russo, MD: So it's really exciting. Um those patients that have a BMI of greater than 35 really should consider a weight loss procedure. If you have reflux and your BMI of greater than 30 to 35, you should consider a weight loss procedure because not only will you lose the weight, but it's actually more effective in terms of resolving reflux than a typical reflux operation. In fact, there are two main operations: one is a little bit more straightforward, it's called the sleeve gastrectomy, which resolves acid reflux in about 50% of individuals, so it's not quite as effective. But actually the most effective bariatric surgery for patients with bad acid reflux is the tried and true gastric bypass that's been around for over 40 years now and it's very very successful at resolving patients of any sort of acid reflux. In fact, it resolves acid reflux in 96% of patients or more. It's our single most effective anti-reflux operation that surgeons can do for a patient.

Deborah Howell (Host): All right, now I want to make sure that I understand. If someone was to have a procedure to relieve their GERD but is still significantly overweight, would the procedure be effective long-term for them?

Michael Russo, MD: It's it's interesting that you bring that up because in fact, if someone does carry a significant amount of extra weight and they have an anti-reflux procedure, which essentially an anti-reflux procedure is just done to strengthen that valve, many times their abdominal weight due to their obesity can even overcome their anti-reflux operation. So in fact, a typical anti-reflux operation like a wrap or a Nissen or the LINX device is not recommended in patients that are morbidly obese, because it actually has a lower success rate than those of normal weight individuals.

Deborah Howell (Host): Interesting. So Doctor, what are some of the things that overweight people with GERD can do to help reduce some of their symptoms before having weight loss surgery?

Michael Russo, MD: Well, first line of defense for all patients with acid reflux is in order to control the symptoms you can try medications. There's a litany of over-the-counter medications as well as prescribed medications that do help patients with acid reflux. However, what you need to remember is that long-term medications may have side effects and the medications are typically just used to neutralize the acid that's refluxing up into the esophagus. The reflux is still occurring, you're just not aware of it. So the single best thing that a patient can do if they're overweight and have acid reflux is lose weight. Okay, so diet and exercise or any sort of procedure - we do non-surgical procedures as well as surgical procedures like bariatric surgery - but the single best thing you can do is lose weight. In addition to avoiding foods that cause increased reflux: caffeine, cigarette smoking, chocolate, spicy foods, large meals.

Deborah Howell (Host): All the good stuff.

Michael Russo, MD: Yeah, exactly.

Deborah Howell (Host): You mentioned some non-surgical procedures. Could you elaborate on that?

Michael Russo, MD: So um we actually offer a new technology, it's called an intragastric balloon, which is essentially a balloon that's inflated in the stomach in patients with a BMI of 30 to 40, left in the stomach for approximately six months. It occupies space in the stomach and makes the patient feel full. And on average we're seeing patients lose about 30 pounds in six months. After the six-month period with the balloon in place, the balloon is removed. This is all done through a camera down the mouth, so there are no incisions, so it's not surgical. And during this entire time that the patient's in the program, they're having monthly visits with our registered dietitian who's in-house to make sure that they have those lifestyle changes that are conducive to keeping that weight off after the balloon's out.

Deborah Howell (Host): And what is the downtime for a procedure like that?

Michael Russo, MD: So essentially the downtime - there's no downtime surgically - but the symptoms after a gastric balloon procedure are essentially the stomach gets a little upset with the balloon in place. So you can have nausea and vomiting for up to two days and then that's it. So essentially two days of just not wanting to go to work and entertain family, but after that you won't even be aware that the balloon is there. Throughout the balloon therapy, yeah, it's really fantastic. Our patients are looking for a non-surgical solution, something that's reversible and has no permanent alteration to their body, but they need to lose 30, 40 pounds. It's really the best thing that's out there. It's four times more effective than diet and exercise alone. So really is the best treatment for them.

Deborah Howell (Host): And then do they remove the balloon after the weight loss is achieved or they keep it in there? What's the deal with that?

Michael Russo, MD: At six at six months all balloons come out, regardless of whether weight loss has been achieved or not. On average, we're seeing that patients lose around 30 pounds. I've had some patients lose well over 40 pounds and I've had some patients lose slightly less than 30 pounds, but all patients have been very happy to maintain the balloon for the six months and really seen some wonderful results.

Deborah Howell (Host): And that also impacts their GERD experience I would think.

Michael Russo, MD: That's right. When the balloon comes out at their new healthy weight, they should see an improvement in GERD-related symptoms.

Deborah Howell (Host): Well, you're just full of good ideas and solutions this morning Dr. Russo.

Michael Russo, MD: That's my job. I love what I do.

Deborah Howell (Host): It's awesome. What should someone do to seek help if they think they're experiencing symptoms of GERD and are also overweight?

Michael Russo, MD: They should call our clinic. We'll be happy to see them, design an individual plan that's tailored for them, and that's all based on what symptoms they're experiencing as well as how much extra weight they carry and we'll find just the right treatment for you to not only get rid of that GERD but shed those unwanted pounds.

Deborah Howell (Host): Well, thank you so much, Dr. Russo, for your time today. We really do appreciate it. Learned a lot. For more information or to listen to this podcast, please go to memorialcare.org/podcasts. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a fantastic day.