What is Post-Sleeve Reflux?
Gastro-oesophageal reflux disease (GORD) is one of the most common complications following laparoscopic sleeve gastrectomy (LSG). Studies report that 20–35% of sleeve gastrectomy patients develop new or worsened reflux symptoms after surgery.
This can significantly impact quality of life and may require ongoing treatment.
Why Does Reflux Occur After Sleeve Gastrectomy?
Altered stomach anatomy: The sleeve creates a high-pressure, narrow tube, which can push stomach acid upward into the oesophagus.
Loss of the angle of His: The normal anti-reflux barrier at the junction of the oesophagus and stomach is disrupted during the sleeve procedure.
Hiatal hernia: A pre-existing or new hiatal hernia can worsen reflux. Some studies suggest hiatal hernias are under-diagnosed at the time of sleeve surgery.
Impaired gastric emptying: In some patients, the sleeve may not empty efficiently, leading to increased pressure and reflux.
Symptoms to Watch For
- Heartburn (burning sensation in the chest)
- Regurgitation of food or sour liquid
- Difficulty swallowing
- Chronic cough, especially at night
- Hoarse voice
- Chest pain
- Nausea
How is Post-Sleeve Reflux Diagnosed?
- Gastroscopy (upper endoscopy) to visualise the oesophagus and stomach
- 24-hour pH monitoring to measure acid exposure
- High-resolution manometry to assess oesophageal function
- Barium swallow to evaluate anatomy
Treatment Options
Lifestyle Modifications
- Elevating the head of the bed
- Avoiding eating within 3 hours of bedtime
- Weight management
- Avoiding trigger foods (caffeine, alcohol, spicy and fatty foods)
Medications
- Proton pump inhibitors (PPIs) such as omeprazole or pantoprazole
- H2 receptor antagonists
Endoscopic Interventions
Anti-reflux procedures may be considered in selected cases.
Conversion Surgery
In severe cases unresponsive to medical treatment, conversion from sleeve to Roux-en-Y gastric bypass may be recommended, as gastric bypass has superior anti-reflux properties.
Prevention Strategies
- Thorough pre-operative assessment for hiatal hernia
- Simultaneous repair of hiatal hernia during sleeve surgery
- Appropriate bougie size selection
- Post-operative PPI prophylaxis
When to Seek Help
- If you develop new reflux symptoms after sleeve gastrectomy
- If existing reflux worsens despite medication
- If you experience difficulty swallowing or unintentional weight loss
- If you have persistent cough or hoarse voice
