Gastric sleeve surgery can worsen symptoms associated with gastroesophageal reflux disorder (GERD).

GERD is a chronic condition associated with frequent bouts of acid reflux. This is when stomach acid moves out of your stomach and up into your esophagus, the tube that connects your throat to your stomach.

Other symptoms of GERD include heartburn, nausea, and difficulty swallowing.

Some people experience GERD symptoms for the first time after gastric sleeve surgery. However, it’s also possible for GERD symptoms to improve after this weight loss procedure.

This article explores the connection between gastric sleeve surgery and GERD.

Gastric sleeve surgery is a type of bariatric surgery. It can help you lose weight quickly. Gastric sleeve surgery is also known as:

  • sleeve gastrectomy (SG)
  • vertical sleeve gastrectomy (VSG)
  • laparoscopic vertical sleeve gastrectomy (LVSG)

The procedure involves a surgeon cutting and removing a large portion of the stomach. The surgeon then joins the edges of the remaining portion of the stomach to form a narrower, sleeve-shaped stomach that’s around a quarter of its former size.

an illustration of gastric sleeve surgeryShare on Pinterest
Illustration: Diego Sabogal

Research has shown conflicting results when it comes to how gastric sleeve surgery affects GERD.

For example, researchers in a 2020 review analyzed two systematic reviews and one meta-analysis evaluating the effects of gastric sleeve surgery on GERD. In all three cases, the results were mixed.

Researchers concluded there’s a link between gastric sleeve surgery and an increase in GERD symptoms over the long term.

A 2021 review also reported that previous reviews have shown mixed results. Researchers cited a number of studies that suggest GERD symptoms are likely to develop, remain the same, or worsen following gastric sleeve surgery.

Researchers in another 2020 review identified three factors that are likely to contribute to GERD symptoms following gastric sleeve surgery:

  • the shape of the sleeve
  • damage to the lower esophageal sphincter
  • the presence of hiatal hernia

Researchers suggested it may be possible to reduce the risk of postsurgery GERD by addressing these issues during surgery.

If you’re considering bariatric surgery, it’s important to talk with your doctor about GERD symptoms. Some weight loss procedures can worsen GERD, while others are more likely to help with symptoms.

Research suggests that gastric bypass, also known as Roux-en-Y gastric bypass (RYGB), is the most effective bariatric surgery for GERD. A 2018 review found that gastric bypass is the best weight loss surgery option for people who also have GERD.

Similarly, researchers in the 2020 and 2021 reviews cited earlier noted that gastric bypass surgery is usually associated with an improvement in GERD symptoms.

In contrast, adjustable gastric banding is another bariatric procedure that appears to increase the long-term likelihood of GERD.

Acid reflux associated with GERD can irritate the esophagus. Over time, this irritation can lead to complications such as:

  • Esophageal ulcers: Frequent acid reflux can cause sores, known as esophageal ulcers, to develop on the inside of the esophagus.
  • Esophageal strictures: Esophageal strictures occur when scar tissue associated with long-term irritation causes the esophagus to narrow. These strictures can make swallowing difficult and increase your risk of choking.
  • Barrett’s esophagus: This complication can occur when exposure to stomach acid leads to changes at the cellular level in the esophagus. Barrett’s esophagus can increase your risk of esophageal cancer.

In addition to the long-term complications, GERD can also have an impact on your day-to-day life. According to a 2020 review, GERD is associated with reduced physical and social activities as well as mental and emotional difficulties.

If you’ve had gastric sleeve surgery, you’ll have several appointments with your doctor in the weeks and months after the procedure. After the first year, your doctor may conduct annual or biannual follow-ups.

If you’re experiencing GERD symptoms, these appointments are a good opportunity to talk with your doctor and let them know. It’s worth mentioning your GERD symptoms even if they’re mild, since symptoms can worsen over time.

Your doctor can help monitor your symptoms and offer treatment options. If you don’t have a follow-up appointment scheduled and GERD is affecting your daily activities, contact your doctor to get the right diagnosis and treatment.

According to a 2020 review, most postsurgery GERD symptoms are treatable with medication. There are a number of over-the-counter and prescription drugs available. These include:

If your symptoms don’t improve with treatment, your doctor may suggest a procedure to convert your gastric sleeve to a gastric bypass.

Although conversion to gastric bypass poses risks, it can improve GERD symptoms in people who previously had gastric sleeve surgery.

Gastric sleeve surgery may increase your risk of GERD. That said, not everyone who gets gastric sleeve surgery experiences acid reflux after the procedure.

If you’re considering bariatric surgery, it’s important to talk with your doctor about your current GERD symptoms. Gastric bypass might be a better option, since it usually helps with GERD.

If you have already had gastric sleeve surgery, be sure to discuss your symptoms with your doctor at your next follow-up appointment.