In recent years, one tool that has become increasingly popular in the fight against obesity and its associated risk factors is bariatric surgery. One of the least invasive options of bariatric surgery is the gastric sleeve. Gastric sleeve is also known as sleeve gastrectomy or vertical sleeve gastrectomy (VSG).

As with any surgical procedure, education is vital. Although weight loss immediately after bariatric surgery is rapid, it is not a quick fix to obesity. Lifelong lifestyle changes are the key to success. Because bariatric surgery is a tool, not a stand-alone solution, weighing the pros and cons and making a well-informed decision will help improve the chances of long-term success.

What is Gastric Sleeve?

Gastric Sleeve surgery involves surgically removing approximately two-thirds of the stomach. The remaining portion of the stomach is sleeve-shaped. Because of the smaller stomach size, the amount of food that an individual can eat is reduced. This reduction leads to feeling full more quickly, reduced caloric intake, and weight loss.

Weight loss can have positive health benefits, including the improvement or reversal of some obesity-related illnesses such as high blood pressure (hypertension), diabetes, and osteoarthritis.

What Is Acid Reflux?

The increased abdominal pressure that is associated with obesity means the risk of developing acid reflux is also increased. An estimated 50% of morbidly obese people experience chronic acid reflux, also known as GERD (Gastro-Esophageal Reflux Disease).

Acid Reflux, often referred to as heartburn, occurs when the lower esophageal sphincter (round muscle at the base of the esophagus) is relaxed, and stomach acid refluxes upward into the esophagus. It is most often characterized by a burning sensation in the center of the chest. Additionally, individuals may experience a sour or bitter taste in the mouth, which is associated with the reflux of gastric juice, including bile.

Some individuals report an improvement in symptoms following gastric sleeve surgery. On the other hand, some patients who never experienced reflux symptoms before gastric sleeve surgery may develop them afterward.

Why Acid Reflux May Improve After VSG

The weight loss that occurs after gastric sleeve surgery leads to a reduction in intra-abdominal pressure. This fact shows that acid reflux after gastric sleeve may improve. The change in the size of the stomach often significantly reduces the production of stomach acid. Additionally, the rate at which the stomach is emptied is increased. The combination of each of these factors prevents the reflux of the stomach contents into the esophagus, which could result in the ease of acid reflux gastric sleeve symptoms.

Why Acid Reflux May Develop After VSG

When sleeve gastrectomy is performed, approximately two-thirds of the stomach is removed. The remaining portion of the stomach is much smaller, resembling the shape of a sleeve. The decreased size leads to increased pressure within the stomach. When VSG is performed, some fibers of the lower esophageal sphincter may be affected. When this occurs, the result is a weakening of the sphincter, which means it is easier for acid to reflux back up into the esophagus from the stomach.

Symptoms of Acid Reflux

Learning the symptoms of acid reflux and knowing when to see a doctor is important, as uncontrolled reflux can cause damage to the esophagus. Common signs and symptoms include:

• Chest pain
• A burning sensation in the chest (heartburn) that usually occurs after eating. Heartburn is often worse at night.
• Regurgitation of food or sour-tasting liquid
• Difficulty swallowing
• The feeling of having a lump in the throat

When acid reflux becomes persistent, individuals may experience laryngitis, disrupted sleep, new or worsening asthma symptoms, and chronic cough.

Dietary Considerations for Acid Reflux After Gastric Sleeve

How can I fix my acid reflux after gastric sleeve surgery? The answer: adhering to a bariatric-friendly diet is essential. Additionally, individuals who suffer from gastric sleeve acid reflux need to consider what foods they are eating that may be contributing to the reflux symptoms. Learning to balance dietary choices with foods that provide the needed protein and nutrients will help minimize the risk of worsening gastric sleeve acid reflux.

Foods That Trigger Acid Reflux After Gastric Sleeve

Fried foods and high-fat foods often cause the lower esophageal sphincter to relax. This fact allows more acid to reflux into the esophagus and can result in uncomfortable symptoms. Additionally, these foods also delay the emptying of stomach contents.

The following foods have high-fat content. Avoid these or eat them sparingly:

• French fries and onion rings
• Full-fat dairy products, such as butter, whole milk, and regular cheese
• Fatty or fried cuts of meat
• Bacon fat, ham fat, and lard
• Desserts or snacks, such as ice cream and potato chips

Fruits and vegetables are important in a healthy diet. Some of these foods, however, can cause or worsen acid reflux and gastric sleeve symptoms. Anyone who experiences frequent acid reflux gastric sleeve should reduce or eliminate the following foods:

• Oranges
• Grapefruit
• Lemons
• Limes
• Pineapple
• Tomatoes, tomato sauce

Chocolate also contains an ingredient that relaxes the lower esophageal sphincter and increases the risk of acid reflux.

Caffeine causes an increase in stomach acid and can trigger reflux in many people. Individuals who drink coffee, especially in the morning before consuming any food, may notice an improvement in acid reflux gastric sleeve symptoms.

Foods That May Ease Acid Reflux After Gastric Sleeve

• Vegetables are naturally low in sugar and fat, and they help reduce acid in the stomach. A few examples of good vegetable choices include asparagus, green beans, broccoli, and leafy greens.
• Ginger is a natural treatment option for heartburn as well as other gastrointestinal problems. It can be added to smoothies or tea to help ease symptoms. Additionally, ginger has natural anti-inflammatory properties.
• Oatmeal can absorb acid in the stomach, thus reducing symptoms of acid reflux.
• Egg Whites. While eggs are a good source of protein, which is an essential part of any bariatric patient’s diet, egg yolks may trigger reflux symptoms. Egg whites, however, may help reduce some reflux symptoms.
• Lean Meats such as turkey, chicken, fish, and seafood are low-fat and reduce acid reflux symptoms. It is best to have meats grilled, baked, or broiled, as fried foods may worsen reflux symptoms.
• Healthy fats can be found in sources such as walnuts, olive oil, sunflower oil, and avocados.

Most bariatric surgeons have a dietician who provides pre- and postoperative counseling for clients. Your dietician can help provide gastric sleeve acid reflux treatment options, if necessary. If you are unsure of what foods you should add to, or remove from your diet, make an appointment to discuss your diet plan. This consultation is essential, as bariatric patients need a diet that is high in protein and essential vitamins. While some changes in dietary habits may be necessary, your physician or dietician can advise you on what is most appropriate for you.

Treatment Options for Acid Reflux After Gastric Sleeve Surgery

Treatment for acid reflux after gastric sleeve surgery may include a combination of dietary changes, as well as medications. While there are over-the-counter medications available, a physician can determine if prescription medications will be more beneficial.

• Antacids reduce the acid levels in the stomach. Most are available in tablet or liquid form. Like any medication, antacids may cause side effects. For example, magnesium salt can cause diarrhea, and aluminum salt can lead to constipation. Antacid products usually combine aluminum and magnesium salts to balance the effects. Additionally, the calcium carbonate ingredients in some antacids provide a good source of calcium but can also cause constipation.
• H2 blockers such as Ranitidine (Zantac) and Famotidine (Pepcid) work to block stomach acid production to provide more extended relief than antacids. When taken before a meal, they have also been shown to prevent heartburn after eating. These medications improve symptoms of heartburn and aid in the healing process of the esophagus, which can become damaged from mild to moderate irritation from heartburn.
• Proton Pump Inhibitors are used to block acid production and allow time for the damaged esophagus to heal. These products include Prevacid, Prilosec, Protonix, Aciphex, and Nexium. Prevacid and Prilosec are available over the counter-the-counter.
• Surgical revision is something that some physicians may recommend, especially if acid reflux symptoms are uncontrolled or if weight loss is inadequate due to complications.

When to See a Doctor For Acid Reflux After Gastric Sleeve

While some individuals experience relief from acid reflux symptoms by taking over-the-counter antacids, knowing when to consult a physician is important.

Some symptoms, such as chest pain, can also be indicative of other medical conditions. If you experience chest pain, especially if it is coupled with jaw or arm pain or shortness of breath, it is vital to seek medical attention immediately. While the symptoms may be severe acid reflux, they are also warning signs of a heart attack and should not be ignored.

Further, if you experience frequent or severe acid reflux symptoms or if you take over-the-counter medications to relieve heartburn symptoms more than twice a week, make an appointment with your physician.

Conclusion

While obesity alone is a risk factor for developing acid reflux, gastric sleeve surgery may also impact its occurrence. For some, symptoms will resolve following surgery and weight loss. For others, acid reflux may develop after surgery. Individuals considering gastric sleeve surgery should be adequately screened for any history of acid reflux. Those with high risk may be advised to opt for an alternate bariatric surgery rather than sleeve gastrectomy. As with any medical decision, it is advisable to consult with your primary health care provider and to have close follow-up before and after any surgical procedure.