Why Is Reflux Common After Esophagectomy?
Why Is Reflux Common After Esophagectomy?
Reflux after esophagectomy is common because surgery changes the anatomy that normally helps prevent food and digestive fluids from moving backward. After surgery, reflux or regurgitation may occur more easily, particularly after eating or when lying down. For some people, nighttime reflux can be one of the more challenging adjustments to life after an esophagectomy.
Key Summary
- Reflux after esophagectomy is common because surgery changes the normal anatomy of the digestive system.
- Symptoms may be more noticeable after eating or when lying down.
- Eating smaller meals, staying upright after eating, allowing time between eating and bedtime, and elevating the upper body during sleep may help some patients manage symptoms.
- There is no single diet or reflux-management strategy that is right for everyone after esophagectomy.
- Persistent, worsening or difficult-to-manage reflux should be discussed with your healthcare team.
- Your physician and, when appropriate, a registered dietitian or nutrition professional can help develop strategies based on your individual health and nutritional needs.
Why Does Esophagectomy Cause Reflux?
An esophagectomy permanently changes the anatomy of the digestive system. During surgery, part or all of the esophagus is removed. The stomach is typically reshaped and brought upward into the chest to reconnect the digestive tract.
This changes one of the body’s natural defenses against reflux. The valve between the esophagus and stomach that normally helps prevent stomach contents from flowing backward is no longer functioning in the same way after surgery.
As a result, gravity becomes much more important. When you are sitting or standing, gravity helps food and digestive fluids move downward. When you lie flat, particularly after eating, stomach contents can more easily travel upward.
Memorial Sloan Kettering Cancer Center explains that reflux after esophagectomy can occur because the valve between the esophagus and stomach is removed during surgery.
Changes in how much you eat, when you eat and how you sleep may help manage reflux after esophagectomy. However, every patient’s recovery is different. Nutritional needs can also be affected by weight, other medical conditions, medications and cancer treatment.
Patients should work with their physician and, when appropriate, a registered dietitian or nutrition professional familiar with cancer care and esophagectomy recovery to determine what works best for their individual needs.
What does reflux after esophagectomy feel like?
Symptoms vary from person to person and may include heartburn or a burning sensation, food or liquid coming back into the throat or mouth, a sour or unpleasant taste, coughing, throat irritation, discomfort after eating, or symptoms that become worse when lying down.
Some people may experience regurgitation without the classic burning sensation they associate with heartburn. That is important because the absence of heartburn does not necessarily mean reflux is not occurring.
Cancer Research UK notes that people living after treatment for esophageal cancer may experience stomach acid coming back into the esophagus when lying flat as well as nighttime coughing.
How should I sleep after an esophagectomy?
Sleeping flat may increase the likelihood that food or fluid will travel upward.
Memorial Sloan Kettering Cancer Center’s esophagectomy guidance advises patients to keep the upper body elevated and cautions against lying flat after eating and while sleeping because of aspiration risk.
A wedge pillow or an appropriately elevated bed can help keep the entire upper body raised. Simply stacking pillows under your head may not provide the same degree of upper-body elevation.
Your surgical team may give you specific instructions about sleeping position and elevation. Follow their recommendations, particularly during your recovery.
When should I talk with my medical team?
Don’t assume that every new or worsening symptom is simply something you have to live with after surgery.
Contact your medical team if reflux is persistent or worsening, significantly interferes with eating or sleeping, or is accompanied by difficulty swallowing, frequent coughing or choking, unexplained weight loss, vomiting, breathing problems or other new symptoms.
Your healthcare team can determine whether reflux is responsible for your symptoms or whether another post-surgical issue should be evaluated.
Frequently Asked Questions About Reflux After Esophagectomy
Is reflux normal after an esophagectomy?
Reflux is common after esophagectomy because surgery changes or removes anatomical structures that normally help prevent stomach contents from moving upward. Symptoms and severity vary considerably among patients.
Why is reflux often worse at night after esophagectomy?
When you lie down, gravity no longer helps keep food and digestive fluids moving downward. This can make reflux or regurgitation more likely, which is why patients are often advised to sleep with their upper body elevated.
Can I sleep flat after an esophagectomy?
Patients are commonly advised to keep their upper body elevated because lying flat can increase reflux and aspiration risk. Follow the specific sleeping instructions provided by your surgeon or medical team.
How long should I wait after eating before going to bed?
Memorial Sloan Kettering recommends having the last meal at least two hours before bedtime and the last drink at least one hour before bedtime. Your healthcare team may recommend different timing based on your individual needs.
What foods should I avoid if I have reflux after esophagectomy?
There is no single list that is appropriate for everyone. Certain foods and beverages may worsen reflux for some patients but not others. Rather than unnecessarily restricting your diet, work with your physician or nutrition professional to identify triggers while making sure your nutritional needs are being met.
Can reflux after esophagectomy cause coughing at night?
It can. Reflux or regurgitation may contribute to nighttime coughing, and aspiration is an important concern after esophagectomy. Persistent coughing, choking or breathing symptoms should be discussed with your medical team.
Will reflux after esophagectomy ever go away?
Reflux may improve or become easier to manage over time, but the anatomical changes caused by an esophagectomy are permanent. Long-term management may therefore be necessary for some patients.
Learning to Live With Your New Anatomy
Recovery from an esophagectomy doesn’t end when you leave the hospital. Eating, digestion and even sleeping can work differently after surgery.
Understanding why reflux after esophagectomy happens can make these changes easier to understand. Smaller meals, staying upright after eating, allowing time between dinner and bedtime and sleeping with the upper body elevated may help, but recovery is individual. What works for one person may not work for another.
ECEF encourages patients to work with their physicians and qualified nutrition professionals to develop an eating and symptom-management plan that considers both their post-esophagectomy needs and their overall health.
For more information about eating, nutrition, dumping syndrome, reflux, weight maintenance and everyday recovery, visit ECEF’s Life After Esophagectomy resource center.
Join Us September 22: Nourish to Flourish
If you’re having difficulty eating after surgery, struggling to maintain your weight, wondering whether you’re getting enough protein, or simply trying to figure out what and how to eat, ECEF’s next Nourish to Flourish webinar is for you.
Join the Esophageal Cancer Education Foundation on September 22 from 7:00–8:00 PM ET for the third installment of our Nourish to Flourish nutrition webinar series.
Anzonette Pittet, RD, CSO, a registered dietitian and board-certified specialist in oncology nutrition, will share practical strategies for nutrition after esophagectomy and answer questions from patients and survivors.
Even if you joined one of our previous Nourish to Flourish webinars, we encourage you to come back. This program will include new information and is part of ECEF’s ongoing nutrition education series for the esophageal cancer community.
Register for Nourish to Flourish →
This information is for educational purposes and is not a substitute for individualized medical or nutrition advice. Talk with your surgeon, oncology team, or registered dietitian about your specific nutritional needs.