Understanding the relationship between sleeve gastrectomy and acid reflux is crucial for patients considering this weight loss surgery. While the procedure offers significant benefits, managing acid reflux effectively can improve long-term outcomes and quality of life.
What is Gastro-Oesophageal Reflux Disease (GORD)?
GORD occurs when stomach acid or content flows back into the oesophagus, irritating its lining and causing symptoms like heartburn and regurgitation. It affects about 20% of the general population and is more common in individuals with obesity.
GORD and Obesity
Obesity is a major risk factor for GORD and related conditions, such as hiatus hernia, oesophageal ulcers, and even oesophageal cancer. Here’s why:
- Increased Intra-Abdominal Pressure: Excess weight puts pressure on the stomach, weakening the lower oesophageal sphincter (LES) and promoting acid reflux.
- Hiatus Hernia: Obesity can push the stomach through the diaphragm, creating a hiatus hernia that further increases reflux risk.
- Delayed Stomach Emptying: Obesity slows gastric emptying, allowing more time for acid to reflux into the oesophagus.
Approximately 60-80% of patients undergoing weight-loss surgery have symptoms of acid reflux, and about 15% have a hiatus hernia.
GORD After Sleeve Gastrectomy
In the first few weeks after sleeve gastrectomy, nearly all patients experience some degree of acid reflux. This is because:
- The stomach tube is small and stiff during the healing process.
- Rapid drinking or large gulps can cause fluid to reflux into the oesophagus.
Most patients find that their symptoms improve as the stomach heals and becomes more pliable. However, 10-20% of patients continue to experience GORD symptoms 12 months or more after surgery. For some, acid reflux becomes a long-term complication of sleeve gastrectomy.
The Effect of Sleeve Gastrectomy on the Anti-Reflux Mechanism
Sleeve gastrectomy has a complex effect on the mechanisms that prevent acid reflux. Some factors increase the risk of GORD, while others reduce it.
Factors That Increase GORD After Sleeve Gastrectomy
- Reduced pressure in the lower oesophageal sphincter (weaker valve).
- Smaller stomach capacity (around 150 mL).
- Reduced stomach compliance (less distensible).
- Increased pressure inside the sleeve.
- Kinking or twisting of the sleeve.
- Failure to repair a hiatus hernia during surgery.
Factors That Reduce GORD After Sleeve Gastrectomy
- Rapid stomach emptying into the intestine.
- Decreased intra-abdominal pressure due to weight loss.
- Increased stomach compliance over time (after 2 years).
- Less acid production by the smaller stomach.
- Removal of the fundus (top part of the stomach).
- Repair of a hiatus hernia during surgery.
What Can Be Done During Sleeve Gastrectomy to Reduce GORD Risk?
While it’s not possible to eliminate the risk of acid reflux entirely, surgeons can take steps to minimize it:
- Proactively search for and repair any hiatus hernia.
- Avoid narrowing the sleeve at the incisura angularis (the angle of the stomach).
- Ensure the sleeve is uniform, with no kinks or twists.
- Fully remove the fundus (top part of the stomach).
- Avoid creating a conical-shaped sleeve, which increases reflux risk.
Managing Acid Reflux After Sleeve Gastrectomy
Diet Modifications
- Avoid drinking liquids 30 minutes before and after meals.
- Do not eat or drink 2 hours before bedtime.
- Avoid trigger foods like coffee, tea, fizzy drinks, citrus fruits, tomatoes, chocolate, mint, alcohol, spicy foods, onions, and garlic.
- Eat slowly and put your fork down between bites.
Lifestyle Changes
- Avoid tight clothing or belts that increase abdominal pressure.
- Raise the head of your bed by 4-6 inches to use gravity to keep stomach acid down.
- Quit smoking, as it increases stomach acid production.
- Exercise regularly to aid weight loss and reduce intra-abdominal pressure.
Medications
- Antacids (e.g., Mylanta, Gaviscon) for occasional symptoms.
- H2 Blockers (e.g., Zantac) for more effective relief.
- Proton Pump Inhibitors (PPIs) (e.g., Nexium, Somac) for severe or persistent symptoms. These should be taken regularly, not just as needed, to avoid rebound acid production.
Surgical or Endoscopic Interventions
For patients with anatomical issues like a dilated fundus, kinked sleeve, or narrowed pylorus, corrective surgery or endoscopic procedures (e.g., balloon dilation) may be necessary. In some cases, conversion to Roux-en-Y Gastric Bypass may be needed.
Patients with Severe GORD: Consider Roux-en-Y Gastric Bypass
For patients with severe GORD who are considering bariatric surgery, sleeve gastrectomy may not be the best option. Instead, Roux-en-Y Gastric Bypass (RYGB) is often recommended because:
- It is highly effective at controlling acid reflux.
- It achieves excellent weight loss results.
- The procedure diverts stomach acid away from the oesophagus, reducing reflux symptoms.
If you have significant reflux before surgery, discuss with your surgeon whether RYGB might be a better choice for you.
Conclusion
Sleeve gastrectomy is a highly effective weight loss procedure, but it can increase the risk of acid reflux in some patients. By understanding the factors that contribute to GORD and taking proactive steps to manage symptoms, patients can achieve better long-term outcomes. For those with severe reflux, Roux-en-Y Gastric Bypass may be a more suitable option.
At Southwest Bariatrics, we’re committed to helping you make informed decisions about your weight loss journey. Contact us today to learn more about your options and how we can support you.
Key Takeaways
- Sleeve gastrectomy can increase the risk of acid reflux in some patients.
- Lifestyle changes, medications, and surgical techniques can help manage GORD.
- Patients with severe reflux before surgery should consider Roux-en-Y Gastric Bypass.
- Individualized care is essential for achieving the best outcomes.
