Reflux After Gastric Sleeve Surgery

Apr 21, 2021

Gastric sleeve, or sleeve gastrectomy as it is commonly called, has become a really popular weight-loss operation, and there are without a doubt some good things going for it.

This operation has taken over from gastric bypass in the United States and was the most commonly performed weight-loss surgical procedure in Europe and the United States in 2018. That’s a big thing because, in the United States, gastric bypass was once considered the gold standard in weight loss surgery.

The main attraction of gastric sleeve surgery is the absence of any foreign body placed into the stomach, besides the need to re route food, like in a bypass. This results in the digestive system continuing to handle food in the way nature originally intended. Food still travels through the food pipe into the stomach and then into the small bowel without redirection or bypass, unlike gastric bypass.

Sleeve gastrectomy is also very effective in assisting with portion size control which is a big challenge for many people. This is another reason for the popularity of the procedure, despite its relative newness.

Although sleeve gastrectomy has numerous benefits, one of the potential drawbacks is reflux, or gastroesophageal reflux disease, after surgery. This concern is often discussed among surgeons and patients and reported in studies.

surgery in surgical theatre

The gastric sleeve procedure converts the stomach into a long tube approximately 60 to 70 per cent smaller than the original stomach. As the stomach is forced to produce the same amount of acid in a smaller volume, pressure increases in the now tubular stomach. The resultant pressure increase must be relieved, resulting in a higher pressure either towards the mouth or lower down at the pylorus valve at the stomach’s base. When acid starts to travel upwards in large volumes, it can manifest in the individual as heartburn.

Heartburn is characterised by the burning sensation that is felt in the chest area just behind the breastbone. Sometimes acid travels up into the mouth, creating a sour taste. Often atypical symptoms of gastro-oesophageal reflux can manifest in the form of persistent coughing, hoarseness of voice, or the need to clear your throat constantly. Some individuals may experience features of asthma that cannot be managed by taking the inhaler.

woman with reflux pain in chest

A question often asked relating to prolonged reflux after sleeve gastrectomy relates to the development of Barrett’s oesophagus. Barrett’s is a condition often seen as a precursor to the development of cancer of the oesophagus.

Long-standing reflux creates a constant burn in the food pipe, which initially manifests into the common reflux symptoms mentioned above. However, over a more extended period, the oesophagus’ inner lining becomes damaged by the acid and begins to lose its protective qualities. This change to the inner lining is Barrett’s.

Barrett’s morphing into cancer can be a long process but is always associated with the symptoms of reflux in all its forms. For this reason, it is vital to manage reflux promptly and to seek medical advice as soon as signs of heartburn are experienced, including the atypical symptoms.

Doctor doing endoscopy

Checking for Barrett’s is carried out by way of an endoscopy which is a day procedure during which photos and biopsies are taken. The results are then analysed to ascertain whether there is any progression of cancer.

It is generally recommended that, even without any symptoms of gastro-oesophageal reflux after your gastric sleeve procedure, it’s a safe strategy to get checked at least once every five years for silent reflux.

It’s also worth mentioning that weight loss surgery is a good option for treating gastro-oesophageal reflux. Because fat collects around the middle part of the body, significant mechanical pressure acts to force acid up into the oesophagus. Reducing the physical amount of fat reduces acidic pressure, thus reducing reflux.

A further benefit of weight loss surgery is the ability to inspect and repair the valve at the point where the food pipe joins the stomach. A ‘loose’ valve, termed hiatal hernia, also contributes to reflux. The combined benefit of surgery and weight loss significantly reduces the incidence of reflux and Barrett’s.

To conclude, if you have new onset reflux after gastric sleeve surgery then it is best to seek medical advise and also perhaps a endoscopy. If you have no reflux symptoms after sleeve and you’re doing fine , it would still be considered safe to have an endoscopic examination in five years.

At Melbourne Gastro Surgery – Centre for Weight Loss, we are currently undertaking a research on the incidence of new onset reflux in gastric sleeve patients, who had no reflux prior to surgery.

If you’re keen to know more about sleeve gastrectomy or any other weight loss surgery option, please book an obligation free appointment with our patient advisor here.

If your considering weight loss surgery, download this free 10 Point checklist.