Question of The Week: Acid Reflux Following Sleeve

I had sleeve surgery about 2 years ago in Dallas. I’ve lost about 40 pounds and still eat pretty small amounts but can’t seem to lose more. I’m about 158 pounds now. I suffer from horrible GERD. Sometimes bile comes into my throat while I’m sleeping and I feel like I’m choking on acid. I’m 44 and take Dexilant, Nexium, Prevacid, alka seltzer, and tums daily. I’m worried about all this medication and my symptoms seem to be getting worse. Thank you

Dear L.,

Your symptom description is highly suggestive of severe GERD post sleeve gastrectomy. A well performed sleeve gastrectomy is expected to resolve acid reflux rather than cause it. I suspect you have a missed hiatal hernia that can be easily corrected. An upper endoscopy as well as upper gastrointestinal contrast study are needed to study the anatomy of your stomach and esophagus. If the sleeve lumen is twisted, narrowed or dilated additional surgery may be needed to correct the problem.

Dexilant, Nexium, Prevacid and other antacid medications are not an effective solution in your case. Bile reflux is very common in missed hiatal hernia following gastric sleeve surgery because the sleeve lumen is rigid and non-compliant. As a result, the negative intra-thoracic pressure is easily transmitted into the sleeve lumen. This creates a suction effect that facilitates the retrograde flow of bile from the duodenum into the gastric lumen and esophagus. Almost every gastric sleeve patient I evaluate for post-operative GERD has evidence of bile gastritis. I have had great success alleviating both bile reflux and bile gastritis by properly repairing a missed or poorly dissected hiatal hernia in sleeve gastrectomy patients. If you had gastric sleeve surgery and currently suffer from acid reflux disease please give us a call. There is no need to suffer and ruin your weight loss journey.