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I am scared to get GERD, please give me advice



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Posted (edited)

Alright so, I'm a 29 year old female, I suffer from High Blood Pressure at this age (so upsetting), Diabetes. I have gone through the 6 month program at my clinic and I'm approved for surgery. My A1c is above 8 right now, so I'm just working on getting that lowered to ~8 at my next blood test, and I'm good to go to get sleeved. Now call me an idiot or a coward, but I am scared to get GERD after the surgery. I know, it sounds so stupid, for Christ's sake I have high blood pressure and Diabetes already, but I feel like if I go through something so drastic as to cut out 70% of my stomach, I just don't want to accumulate other diseases like GERD and still be bound to take medications everyday for other diseases acquired - does that make sense to anyone? I want to get this procedure done (And let me tell you, I am soo scared still to do it, but I know it is the best option for me considering my health status), I just feel like let's say I do get GERD, there is all this talk about sleevers down the line getting revisions, I don't wanna be a non-normal person getting surgeries and other procedures done all the time to feel normal. What advice can anyone give me to relieve my nerves? As of right now, I do sometimes get heart burn if I eat something spicy - i don't take any medications for it. I would say it happens 2-3 times a month. Is there a possibility I will get chronic GERD after surgery and I will need a revision done later on in life?

Any advice would help me out!!! I'm a confused mess right now....

Edited by AchieveGoals
made it simpler

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14 minutes ago, AchieveGoals said:

I just don't want to accumulate other diseases like GERD and still be bound to take medications everyday for other diseases acquired - does that make sense to anyone?

It doesn't sound stupid at all and it makes a lot of sense. It's important to consider these things before making a decision and not be lured into getting a specific procedure because e. g. your surgeon has a personal preference for it for whatever reason or because it seems to be "the procedure to get" right now or because it promises the "best weight loss possible".

Quote

Is there a possibility I will get chronic GERD after surgery and I will need a revision done later on in life?

Yes, it's absolutely possible. However, this seems to be possible after getting a bypass as well.

Unfortunately there are many things to consider before choosing a procedure. GERD, malabsorption, possible food sensitivities...

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GERD is a real consideration to take into account when thinking about which type of WLS to choose.

However, the fact that you have diabetes is also very important to your decision. Work with your team, ask them very specific questions about your case and what their recommendations are and why.

Good Luck💜

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Did you and your surgeon ever consider gastric bypass? I think it is possible to develop GERD after sleeve. Bypasd totally eliminated my diabetes and I have halved my high blood pressure medication. I expect to be off that medication soon. I don't believe GERD increases after bypass because there is almost no stomach acid in the pouch, and bypass is a low pressure system, while sleeve is high pressure. I certainly Don't mean to confuse you further. I just wanted to give you an idea of my success with bypass if you hadn't considered it. Of course the decision is totally between you and your surgeon, and I'm sure many people have the sleeve and Don't develop GERD. Good luck with your surgery!

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Look into the bypass, one of the best decision I ever made

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yes - GERD is a possible complication of the sleeve. That's not to say it's inevitable, but it is a risk and therefore, it's not recommended for people who already have pre-existing GERD. Gastric bypass often improves or even cures GERD.

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2 hours ago, summerset said:

Yes, it's absolutely possible. However, this seems to be possible after getting a bypass as well.

the second part of this isn't true - bypass usually improves or even cures GERD. In fact, many sleevers who develop severe GERD (and certainly not all will - but a significant minority) revise to bypass for that reason.

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1 minute ago, catwoman7 said:

the second part of this isn't true - bypass usually improves or even cures GERD.

Usually doesn't mean always. It also doesn't mean that gastric bypass patients never develop GERD. Also how can you claim bypass patients never develop GERD? That's a bit like claiming thin people can never develop type 2 diabetes. Their risk is lower but it's not zero.

Interesting read on curing GERD with bypass, btw: https://www.medscape.com/viewarticle/913919 (which is way less optimistic than the 80% I was told a few years back).

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10 minutes ago, summerset said:

Usually doesn't mean always. It also doesn't mean that gastric bypass patients never develop GERD. Also how can you claim bypass patients never develop GERD? That's a bit like claiming thin people can never develop type 2 diabetes. Their risk is lower but it's not zero.

Interesting read on curing GERD with bypass, btw: https://www.medscape.com/viewarticle/913919 (which is way less optimistic than the 80% I was told a few years back).

did I say bypass patients never develop GERD? I also did not say it ALWAYS improves or cures GERD. I said it USUALLY does.

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I had GERD for many years before WLS surgery. I had the sleeve 7 months ago. Now I no longer have GERD.

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You should have an endoscopy before you’re approved and that will show whether there are indications that you may develop GERD. Of course, there is always a chance of it but if you have no indications now, I’d say the chances are lower.

Since spicy foods already give you heartburn, I would stay away from them post-op. I loved spicy food before but really can’t tolerate it anymore.


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Posted (edited)

Your pre-op endoscope is a very important piece of information. If there is already gastritis, esophagitis, or any any indication of Barrett's, all of which would point to a problem with reflux, then bypass may be a better option. I actually had a Barrett's polyp - a pre-cancerous lesion from chronic GERD. (I never knew my GERD was that bad, but the Barretts and my vocal hoarseness said otherwise.) Anyway, my GERD is completely gone after bypass. I get another endoscope in a few months to check out the situation. I am so glad I went this route. All being said, your endoscope results are important.

Edited by AZhiker

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Most any surgery that you can contemplate, in addition to the basic risks associated with surgery, hospitals and anesthesia, will have some risk of side effects that may be less than desirable, however we take those risks in order to correct a problem that we have created by injury, disease or genetics, with the intent that the result will be much better than what we started with.

The various bariatric procedures have different predispositions to consider - conditions that happen more commonly than in the general population. The VSG is predisposed to GERD as the stomach volume is reduced much more than its' acid producing potential, and while usually the body adjusts and corrects the problem, sometimes it doesn't completely. Similarly, the RNY is predisposed to marginal ulcers (typically around the anastomosis) because the part of intestine to which the stomach pouch is attached is not resistant to the stomach acid like the duodenum is (the part of intestine immediately below the stomach outlet, which is bypassed along with the remnant stomach.) Likewise, it is also predisposed to dumping and reactive hypoglycemia owing to more rapid stomach emptying due to the lack of pyloric valve.

Usually, these problems don't hit most patients, or don't persist if they do, but sometimes they are long term problems. These are things to consider ahead of time, particularly if one has any relevant pre-existing condition.

Another consideration is that the VSG is fairly easy to revise if it does run into a problem that can't be resolved otherwise, while the RNY is difficult to revise or reverse. Another point to consider is that while the sleeve leaves behind a relatively "normal" anatomy, the bypass leaves a blind stomach and upper intestine which is more difficult to examine endoscopically, so some problems may not be diagnosed until they are more advanced and symptomatic. For instance, if one is subject to stomach polyps, that is a pre-cancerous condition that should be monitored, but is difficult to do after a bypass. An pre-op endoscopy is a good idea to understand what is happening inside you, even if your program doesn't require one.

On the diabetes front, they both do well, typically seeing 75-85% remission rates (remission is what it is, rather than a "cure" - it can come back, particularly with some weight regain) though the bypass is generally considered to be marginally better. The best results come from the Duodenal Switch which typically shows remission rates in the 98-99% range, but that is a more complex procedure that few surgeons offer. However, if the diabetes fails to go into remission, or comes back, after a VSG, a revision to the DS is straightforward (as the DS uses the VSG as its basis) while revising an RNY to a DS is very complicated, which only a handful of surgeons are able to perform. So, while the VSG may not be quite as good as the RNY in that respect, it has a much more viable "plan B".

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I had my sleeve surgery July 8, 2019 and I am off my blood pressure meds already. My dr stopped it last Monday because my blood pressure is perfect without it now. My A1c went to a 7, so technically I was diagnosed with diabetes right before surgery. I was told this would most likely resolve diabetes. My Mother had diabetes really bad so this was a big push for me to stop it in its tracks. My health issues is the reason I had my surgery. I know when they did the endoscopy they did a test for GERD and if you had it they didn’t do the sleeve, they do the bypass. You are young, get started now and enjoy your life. Talk to your surgeon and don’t worry it will all work out.

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14 hours ago, RickM said:

Most any surgery that you can contemplate, in addition to the basic risks associated with surgery, hospitals and anesthesia, will have some risk of side effects that may be less than desirable, however we take those risks in order to correct a problem that we have created by injury, disease or genetics, with the intent that the result will be much better than what we started with.

The various bariatric procedures have different predispositions to consider - conditions that happen more commonly than in the general population. The VSG is predisposed to GERD as the stomach volume is reduced much more than its' acid producing potential, and while usually the body adjusts and corrects the problem, sometimes it doesn't completely. Similarly, the RNY is predisposed to marginal ulcers (typically around the anastomosis) because the part of intestine to which the stomach pouch is attached is not resistant to the stomach acid like the duodenum is (the part of intestine immediately below the stomach outlet, which is bypassed along with the remnant stomach.) Likewise, it is also predisposed to dumping and reactive hypoglycemia owing to more rapid stomach emptying due to the lack of pyloric valve.

Usually, these problems don't hit most patients, or don't persist if they do, but sometimes they are long term problems. These are things to consider ahead of time, particularly if one has any relevant pre-existing condition.

Another consideration is that the VSG is fairly easy to revise if it does run into a problem that can't be resolved otherwise, while the RNY is difficult to revise or reverse. Another point to consider is that while the sleeve leaves behind a relatively "normal" anatomy, the bypass leaves a blind stomach and upper intestine which is more difficult to examine endoscopically, so some problems may not be diagnosed until they are more advanced and symptomatic. For instance, if one is subject to stomach polyps, that is a pre-cancerous condition that should be monitored, but is difficult to do after a bypass. An pre-op endoscopy is a good idea to understand what is happening inside you, even if your program doesn't require one.

On the diabetes front, they both do well, typically seeing 75-85% remission rates (remission is what it is, rather than a "cure" - it can come back, particularly with some weight regain) though the bypass is generally considered to be marginally better. The best results come from the Duodenal Switch which typically shows remission rates in the 98-99% range, but that is a more complex procedure that few surgeons offer. However, if the diabetes fails to go into remission, or comes back, after a VSG, a revision to the DS is straightforward (as the DS uses the VSG as its basis) while revising an RNY to a DS is very complicated, which only a handful of surgeons are able to perform. So, while the VSG may not be quite as good as the RNY in that respect, it has a much more viable "plan B".

You are very knowledgeable! This is why I chose the vsg, if needed I can revise, which I prefer not, but we will see what the future holds. My Dr wanted me to do the DS, but I refused, for now.

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