The Relationship Between the Gastric Sleeve and Acid Reflux

It is estimated that 20 to 30 million people in the United States suffer from chronic acid reflux also known as GERD or gastroesophageal reflux disease. It’s a shocking number that has led to compromised quality of life, long term PPI (Proton Pump Inhibitor) therapy, and a rise in esophageal cancer. For some, bariatric surgery may be the answer to losing weight and eliminating many of the effects of GERD. However, some bariatric procedures, including the gastric sleeve, may, paradoxically, cause or worsen existing acid reflux issues.

For patients with severe or poorly controlled acid reflux, the gastric sleeve may create additional pressure on the Lower Esophageal Sphincter or LES, causing worsened reflux. This is also true for patients that have a weak LES but are not yet experiencing acid reflux symptoms. Why does this happen? Think of the stomach as a pressurized tube – much like an airplane. If the size of that tube shrinks, additional pressure may be placed on the outlets at either end. In this case, the upper end – the LES – tends to give way first and this allows the contents of the stomach to reflux back into the esophagus.

We have found that repairing a hiatal hernia, if present (and it often is in obese patients) reduces the incidence of post gastric sleeve reflux tremendously. However, the risk is still there and runs anywhere between 10 and 20%. Therefore, for patients with significant acid reflux issues before surgery, we weigh the gastric sleeve versus the gastric bypass very carefully – often, the gastric bypass is the better procedure.

For those that do experience severe reflux after the gastric sleeve, we have options. Unfortunately, Transoral Incisionless Fundoplication or TIF is not an ideal procedure for gastric sleeve patients as the fundus of the stomach has been removed during the procedure. However, the gastric sleeve can easily be converted to a gastric bypass, if necessary. This usually resolves any acid reflux issues.

The Bottom Line

The gastric sleeve is an extremely effective procedure to help patients improve their obesity issues and regain quality-of-life and normalcy in their health. Bariatric surgery has made leaps and bounds in terms of safety and effectiveness and Dr. Chang has the experience and expertise to help you choose the right procedure for your particular circumstance.

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