Undergoing sleeve gastrectomy, commonly known as vertical sleeve gastrectomy (VSG), is a life-changing procedure for those battling obesity. It offers not only significant weight loss but also improvements in obesity-related health conditions. However, many patients experience new or worsened symptoms of gastroesophageal reflux disease (GERD), commonly referred to as reflux or heartburn. Understanding the causes, potential long-term problems, prevention strategies, and treatment options is crucial for maintaining your quality of life after surgery.
Causes of Reflux and Heartburn After Sleeve Gastrectomy
After VSG, the new shape and size of the stomach can significantly affect how it functions. The reduced stomach volume can increase internal pressure, which in turn may place added stress on the lower esophageal sphincter (LES). When this valve-like region at the junction of the stomach and esophagus weakens or relaxes inappropriately, it can lead to reflux of stomach acids into the esophagus, causing the discomfort known as heartburn.
Long-Term Problems Caused by Gastroesophageal Reflux
If left untreated, chronic exposure to stomach acids can damage the lining of the esophagus and lead to more serious conditions such as:
- Esophagitis: Inflammation of the esophagus, which can cause pain and discomfort.
- Barrett’s Esophagus: A precancerous change in the lining of the esophagus that significantly increases the risk of esophageal cancer.
- Stricture Formation: Narrowing of the esophagus due to chronic scarring, which can result in swallowing difficulties.
Prevention Methods
Prevention of reflux and heartburn starts with a thorough preoperative evaluation. Candidacy for VSG includes an assessment of existing GERD symptoms. Patients should be informed about the risk of developing reflux postoperatively.
Surgical technique also plays a role in prevention. Ensuring the correct size of the sleeve and avoiding an overly tight or narrow gastric tube can reduce the risk of developing reflux symptoms after surgery. Some surgeons (like myself) also advocate for routine hiatal hernia repair during VSG if present.
Postoperative medications such as proton pump inhibitors (PPIs) are often prescribed to reduce gastric acid production and help prevent reflux while the surgical site heals.
Non-Surgical Treatment Options
Lifestyle modifications are the first line of defense when dealing with GERD. Recommendations may include:
- Eating smaller meals to avoid over-distension of the stomach.
- Avoiding eating late at night to reduce nighttime reflux episodes.
- Raising the head of your bed slightly to prevent esophageal reflux during sleep.
Medications are also a significant component of non-surgical treatment. PPIs, H2 blockers, and antacids can all be used to manage symptoms, although they may not address the root cause of increased gastric pressure.
Surgical Treatment Options
When lifestyle changes and medications fail to control reflux symptoms, surgical options must be considered. These can include:
Revision surgery: Adjusting the sleeve or correcting any anatomical abnormalities that could be contributing to reflux.
Conversion to gastric bypass: This is often considered a more definitive treatment for GERD, as the anatomy changes in gastric bypass reduce the opportunity for reflux to occur.
Lifestyle Changes Post-Surgery
In addition to the lifestyle changes aimed at reducing GERD symptoms, patients should be mindful of other post-VSG care recommendations such as:
Dietary modifications: Opting for a diet high in protein and low in fats and sugars can help manage weight and reduce GERD symptoms.
Eating habits: Chewing food thoroughly, eating slowly, and avoiding drinking large amounts of liquids with meals can help prevent overfilling of the sleeve.
Regular exercise: Maintaining an active lifestyle helps with weight management, which can reduce the risk of exacerbating GERD symptoms.
Conclusion
Living with reflux and heartburn following sleeve gastrectomy can impact your overall well-being and satisfaction with the surgery outcome. By understanding the mechanisms and risks, adopting prevention techniques, and exploring all treatment avenues, you can mitigate the discomfort and long-term risks associated with GERD. Through collaborative care and informed choices, an improved quality of life after VSG is within reach. If you or someone you know is suffering from GERD or heartburn after a sleeve gastrectomy, give us a call at Beltline Health. You have options and I can help.
