Why do so many sleevers get GERD?

[Panda333 276]

Hi Folks, been scouring the posts and it seems like most sleevers get GERD, which is disconcerting but I know it's preferable to being overweight. Are you getting GERD because your surgeon made your sleeve too small? I'm specifically asking if you didn't have GERD before. Thinking I might just switch my surgery to the bypass to avoid this. I still don't know which procedure to get...ARGH

[notmyname 593]

Most sleevers don't get GERD if they didn't have it before - it just seems that way because people don't really post the positive - you're FAR more likely to see a post about getting GERD than a post about not having a side effect/complication. According to some studies, about 9% of people who are sleeeved get GERD (the title in the link to this article is a bit misleading: https://www.mdedge.com/gihepnews/article/80250/gastroenterology/sleeve-gastrectomy-often-worsens-gerd)

According to the article: "Most LSG patients [who had GERD before surgery] (84.1%) had persistent GERD symptoms after the procedure; only 15.9% reported resolution of symptoms. An additional 9.0% of LSG patients reported postoperative worsening of GERD symptoms. And 8.6% of patients who didn’t have GERD before undergoing sleeve gastrectomy developed the disorder afterward."

So, if you don't have GERD now, this study would say you have an 8.6% chance of getting it afterwards. Most of the people I've met who have had the sleeve have no GERD (and one bypass patient I know does). And the few sleevers I know who do have GERD have it well under control with medicaiton.

In the end, read the studies. Talk to your surgeon. Have you had an endoscopy - talk to your surgeon about the results and what s/he thinks it means for the likeliness of getting GERD.

As to why - my understanding is that because you're stomach basically becomes a tube, the pressure in your stomach increases, which increases the chance of the acid being forced back into the esophagus. This is a really nerdy article, but Table 1 talks about why obese people in general have a higher incidence of GERD, why someone might newly get GERD after sleeve (de novo column), or why GERD might get better after sleeve ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579881/

NOTE going into the next paragraph - my experience is NOT typical. I know some on this board would prefer that people don't talk about their bad outcomes, but I feel like people should know that a small number of patients do get the. I'd also say that, for me, some presentations of GERD are not preferable to being overweight. Unfortunately, my surgeon gave me the 8.6% figure as ALL sleeve patients - he didn't give me the #s on people who had GERD before (I recognize I should have done more of my own research - I did some, but somehow didn't see the study linked to above). I had a bit of GERD that was very well controlled before surgery. I felt great for about 3 months post-surgery. Months 4-5 were so rough with GERD I could barely eat (I struggled to get 3-400 calories vs. eating about 700 in the few months after surgery) and struggled every waking moment not to throw up. It is better now (at 8 months), but I still have GERD and can tell you at any given time exactly where the acid is in my esophagus. I can tell you that at months 4-5, I would have 100% taken all the weight back to feel better. And even now I seriously regret the surgery and would trade the 125-ish lbs loss to feel like I did before surgery (edited to add - I also have other complications, so its not just the GERD that makes me regret this - but I likely would have had the other complications with RNY, too). But, for various personal reasons that really only apply to me, I wouldn't have had the RNY and still won't convert. So, I'm working on it in therapy because it is not mentally healthy to continually regret a decision I can't take back.

Edited June 30, 2019 by notmyname

[victoriaobe 24]

I didn’t have GERD/ acid reflux until after the sleeve. I ended up with 4 ulcers in my esophagus. I just had revision surgery to the gastric bypass on Monday.

[KCgirl061 1,533]

This was a concern of mine too. Especially on the Facebook bypass support groups I was on. They were saying that 25% of sleevers end up getting converted. Yikes! But you can’t believe everything you read on the internet and so I went looking for more reliable sources of information - namely medical studies. Sorry I didn’t save the links so you can read them for yourself but I have screenshots of the information I wanted:

As you can see, the numbers are actually quite small! So don't feel you have to worry about getting a revision - statistics are in your favor!

Edited July 1, 2019 by KCgirl061

[Moa 34]

I had bad GERD before surgery...all gone now and not taking PPI's anymore!! I try to not eat too much (my stomach tells me when it's time to stop) or right before bedtime, which are just common sense things.

[revyinut 2]

I had no digestive issues whatsoever before getting the sleeve. Now I have GERD and it so much worse than just some heartburn. It has recently become unbearable and something I think about almost constantly. My surgeon now tells me how common GERD is after the sleeve. So, I don't know about statistics, where they come from, or how accurate they are but it most definitely happens and it is something to be seriously concerned about.

[Coexister 114]

I had a hiatal hernia along with the sleeve performed over a year ago, December 26, 2018. I recently lost my voice and coughed up some blood. I thought it was due to allergies and just happened to have an appointment with my ENT specialist for my semi annual ear check up as I have ongoing ear problems. I told him about my voice and coughing up blood and so he decided to scope my throat and put a tube down my nose into my throat to take a look. He said I had blood on the back of my tongue and on my vocal chords but that he could see no reason for it being there and that he believed it was acid backing up from my stomach and irritating my chords and throat causing my issues. He asked if I had been having heartburn and reflux issues and I told him I am not sure. It always hurts when I eat so I have just accepted that as the new normal. I told him maybe that's why my stomach has been hurting the past couple of months? However my regular doctor has been blowing that off and said she thought is was just due to PTSD and in my head? Anyways so my ENT wants to refer me to a GI doctor and told me to get back on Pantaprazole which I had taken pre-sleeve surgery for GERD because it was tearing up my throat at that time. This time for some reason I just didn't connect it as it doesn't feel the same and allergens have been high. However, I was awaken a few nights later about 3 in the morning with a feeling a choking and something rolling up my throat and I quickly swollen it back down. The scary part is that I have been on the pantaprazole for awhile. I had a very hard time falling back to sleep because it irritated everything in my throat and caused m coughing spasmns so I had to get up and use a netty pot to rinse my nasals, bush my teeth to get my back tooth from stopping to hurt because I think the acid had hurt this as well? Before bushing I chewed on some tums. The hardest part of all of this is that I haven't worked in over a year and I just can't afford to see the specialist or the dentist and can't afford all these appointments or needed test. I had three surgeries last year , shoulder, ventral hernia repair and am now recovering from a foot surgery. I do have the insurance but we have started over in out of pockets and deductibles. Is there anyway to beat this acid reflux without a doctor? should I just eat really tiny portions? Go all liquid? I am so so frustrated and scared. I mean this stuff had got my vocal chords all tore up and bleeding. I am losing my voice over it. Sorry this is so long. I just needed to vent. HELP.

[Jay19 76]

I’m almost 6 months post sleeve and I’ve had zero complications! I did not have gerd prior to surgery either.

[Losingit2018 1,170]

I never had gerd or even heartburn before being sleeved. I ended up with gerd and a hiatal hernia. The sleeve creates high pressure on remainder stomach after surgery. This is why it is so easy to end up with gerd post sleeve.