Weight loss surgery should be carefully considered and researched to know if this procedure can effectively treat, prevent, and eliminate chronic heartburn while losing weight.

The vertical sleeve gastrectomy, most commonly known as the gastric sleeve, is a popular weight loss surgery. The gastric sleeve is one of the most common bariatric surgeries that treat morbid obesity.

Even though there are risks involved with gastric sleeve surgery, it is preferred because it is safer than other weight-loss surgeries. There is no known significant nutritional deficiency with having gastric sleeve surgery. However, heartburn after gastric sleeve can increase. The operation can increase heartburn episodes and, more seriously, gastroesophageal reflux disease (GERD) after surgery.

Heartburn, more commonly known as acid reflux, may improve or get worse after gastric sleeve surgery. Some bariatric patients who do not have any heartburn symptoms may develop these symptoms after their gastric sleeve surgery.

Acid reflux and obesity are usually related to one another. 50% of morbidly obese patients have regular acid reflux. One specific reason morbidly obese patients have excessive acid reflux is increased abdominal pressure, and the relaxation of the lower esophageal sphincter.

The lower esophageal sphincter or LES is a collection of muscles at the bottom of the esophagus that meets the stomach. When the LES is working correctly, it prevents acid and stomach contents from traveling backward from the stomach. When this function is disrupted, acid reflux is the common side effect because the LES is no longer working correctly.  

What is Gastric Sleeve Heartburn?

The gastric sleeve is a weight loss surgery where your stomach is significantly reduced to 80% of its original size. The remaining shape is the size of a banana, thus giving you a sleeve. Because of your reduced stomach capacity, your appetite and ability to consume regular portions are significantly smaller. With a smaller stomach, you lose weight quickly, which is an effective treatment for morbid obesity.

When you have gastric sleeve surgery, you risk increasing your chances of having regular heartburn episodes. Heartburn is a painful burning feeling in your chest or throat. This happens when your stomach acid moves back towards your esophagus. This is a concern when you already have had regular heartburn episodes before surgery.

Your esophagus carries food from your mouth to your stomach. If you have heartburn more than twice a week, you may have gastroesophageal reflux disease or GERD. You can have GERD without having heartburn.  GERD is a long term condition where your stomach acid comes up into your esophagus. Many people regularly experience gastric sleeve heartburn, but when it occurs more than twice a week, you can be diagnosed with GERD.

Symptoms of Heartburn After Gastric Sleeve Surgery

Common symptoms of heartburn are regurgitation and dyspepsia. Regurgitation is when acid moves back up into your throat or mouth. This can produce a sour or bitter taste in your mouth. You may even vomit or burp up some of your stomach's content when experiencing this aspect of heartburn.

Dyspepsia is another side effect of heartburn where your stomach is uncomfortable, and you experience many incidents of burping, nausea after eating, fullness, or bloating in your stomach. All of these symptoms are incredibly uncomfortable and make digesting food extremely difficult.

Symptoms of gastroesophageal reflux disease include trouble swallowing throat clearing, sore throat, wheezing, chronic cough, asthma, laryngitis, sleep apnea, and chest pain.

After having gastric sleeve surgery, you can contribute to your acid reflux by overeating, not drinking enough fluids and eating spicy foods. All of these habits contribute to your digestive health, so monitoring how much and how often you eat is crucial for a healthy digestive system.

Gastric Sleeve or Gastric Bypass?

A study of 39,000 patients found that gastric bypass procedures reduce heartburn and acid reflux symptoms, whereas the gastric sleeve surgery was unhelpful in treating and preventing GERD. Also, 1 in 11 people who did not have GERD before their gastric sleeve surgery developed the condition after surgery.

Severe heartburn after gastric sleeve or GERD development is a critical medical condition that requires adequate research before deciding which weight loss surgery is best. Having chronic exposure to stomach acid changes how your cells line your esophagus. Significant and reoccurring exposure to stomach acid leads to scar tissue, which can lead to trouble swallowing.

Some theories exist as to why gastric sleeve surgery produces more acid reflux complications than gastric bypass surgery are due to the stomach's reduced size. With the gastric sleeve, your stomach may retain more acid production, which causes acid reflux. Also, your stomach may lack the ability to clear the esophageal acid due to its sleeve size.

The exact reason for acid reflux is unknown. Research does show that the gastric sleeve surgery fails to improve GERD symptoms in most patients and severe heartburn after gastric sleeve or GERD symptoms worsen after surgery.

One in five people experiences heartburn weekly. Two in five people have heartburn at least once a month. Heartburn as frequent as twice a week indicates GERD. Having GERD affects your choice for bariatric surgery.  To remain on the safe side, every patient with reoccurring acid reflux should be evaluated, and other surgical options should be considered in treating obesity.

Treatment for Heartburn Gastric Sleeve

Morbid obesity and excessive weight in adults indicate a higher likelihood of heartburn. Having a body mass index or BMI over 30 means you are 2.5 times more likely to have acid reflux, or GERD related a problem that damages your esophagus.  One theory for the excessive weight and acid reflux correlation is that the excess weight puts pressure on the abdomen, which presses against the stomach and pushes the contents back towards the esophagus.

The main form of treatment for acid reflux and GERD is weight loss through weight management or surgery to improve acid reflux symptoms.

Another treatment method for heartburn after gastric sleeve is medication. Proton pump inhibitors or PPIs are medications that treat acid reflux. These medications reduce the production of acid by blocking the wall of the stomach that produces acid. Some common examples of PPIs are Prilosec, Nexium, and Aspirin.

My Heartburn Experience

When I was at my most substantial weight before my gastric sleeve surgery, I would experience regular GERD symptoms every week. My symptoms were frequent vomiting, stomach irritation, and overall discomfort when eating any food. The reasons for my acid reflux were due to stress from unresolved trauma and my morbid obesity.

With therapy and increasing my physical activity, I was able to lose weight, and my acid reflux symptoms went away. Since my gastric sleeve surgery, I have had only mild digestive irritation when I eat too fast and do not chew food thoroughly. Overall my digestive system is working well, and I have had no significant acid reflux episode since my surgery.