Sleeve Gastrectomy Can Improve Symptoms of Acid Reflux
Symptoms of acid reflux or Gastroesophageal reflux disease (GERD) include the typical burning sensation in the chest or behind the breast bone, a feeling of pressure inside the chest, or food coming back into the mouth. Many of our patients already have symptoms of acid reflux and are already on medications for it. Medications for reflux include antacids (Tums), H2 blockers (Pepcid / Tagamet), or Proton-Pump Inhibitors / PPIs (Nexium / Protonix / Dexilant). Some patients experience reflux symptoms only occasionally when they enjoy the typical culprits; fattier, greasier foods, spicy foods, red sauces, or other acidic foods. Other patients experience symptoms daily to any foods they eat.
Numerous studies show a reduction in reflux symptoms after a sleeve gastrectomy. This is primarily because obesity is one of the main drivers of reflux symptoms. Obesity causes more intra-abdominal pressure, which then pushes acid and stomach juices back up the stomach into the esophagus (the food pipe). After a sleeve gastrectomy, patients lose a significant amount of weight. As a result of the weight loss, the intra-abdominal pressure is lowered, and therefore GERD symptoms are better controlled.
In addition, at the time of the sleeve gastrectomy, we will repair a hiatal hernia if found, which significantly contributes to acid reduction post-sleeve gastrectomy. A hiatal hernia is a type of hernia on the inside of your body. and cannot be seen on the outside. In a hiatal hernia, the stomach passes through an enlarged opening in the diaphragm, the muscle that separates the chest from the abdomen and helps you breathe. With a hiatal hernia, the first part of the stomach is actually in the chest. Since the stomach is no longer in its correct position, the stomach does not function properly and acid then can travel very easily up into the esophagus, leading to symptoms of reflux.
If a hiatal hernia is found during your sleeve gastrectomy surgery, we will repair it at the same time. To repair a hiatal hernia, we remove the scar tissue that keeps the stomach stuck in the chest and return the stomach back into the abdominal cavity where the stomach belongs. We then will repair the opening in the diaphragm that the stomach was previously sneaking up through. Once the stomach is back in the abdominal cavity, we then proceed with the sleeve gastrectomy. We need to repair the hiatal hernia not only to cure the reflux but to also make sure we don’t leave a large stomach up in the chest that does not get sleeved! The weight loss after a sleeve gastrectomy, with a combined hiatal hernia repair if needed, significantly reduces reflux symptoms after surgery and makes the sleeve gastrectomy an anti-reflux surgery for many patients.
Conversely, some studies do show that a sleeve gastrectomy can worsen co-existing symptoms of reflux or cause a patient to develop new reflux symptoms after surgery. It is difficult to fully predict which patients have their reflux cured or which patients continue to have reflux after surgery. If you have severe reflux symptoms, your surgeon may want to perform an EGD (endoscopic camera down the mouth), or an Upper GI exam (an X-ray swallow test), prior to surgery to evaluate the severity of the reflux. If your reflux is very severe, your surgeon may want to consider other options than a sleeve gastrectomy, such as a Roux-En-Y gastric bypass.
If you develop symptoms of reflux after a sleeve gastrectomy, talk to your surgeon. Especially during the initial weeks of healing, some reflux symptoms are common. The stomach is quite tight and inflamed as it heals, leading to a backup of stomach acid and symptoms of reflux. As the stomach heals and relaxes, the stomach acid travels through the stomach better and reflux symptoms also get better. Medication, such as a daily PPI, oftentimes can control the symptoms of reflux. If the reflux persists after a sleeve gastrectomy, is very bothersome, and is not responsive to medications, make sure to reach out to your bariatric surgeon. Workup for post-sleeve reflux can include an EGD or UGI to rule out any associated hiatal hernia. With the results of additional testing, your surgeon may suggest revisional surgery, such as a hiatal hernia repair, a conversion to a Roux-en-Y gastric bypass, or a conversion to a duodenal switch.
The relationship between sleeve gastrectomy and acid reflux is a complicated topic so make sure to talk to your bariatric surgeon regarding all of your options!
