Reflux after a sleeve

Reflux is one of the most common side effects of a sleeve. While not everyone experiences reflux after sleeve gastrectomy, it is possible that you’ll need to seek treatment for it. Let’s look at the common causes and what you can do to minimise your chances of experiencing it.

What is reflux?

Reflux or heartburn is a burning sensation felt in the oesophagus, usually due to a weakening of the sphincter between the oesophagus and the stomach isn’t closing properly and the acid from your stomach flows back into the oesophagus. The pain of reflux is more likely to happen after eating or when you are lying down (gravity isn’t helping you out…), so people often experience reflux during the night.

Gastro Eosophageal Reflux Disease (GERD) is frequent and chronic reflux – usually when reflux is experienced more than twice a week. If left untreated, GERD can lead to serious health issues such as Barrett’s Oesophagus, where the tissue in the lower oesophagus changes to be more acid-resistant like the tissue in the stomach and small intestine. Barrett’s Oesophagus is a risk factor for oesophageal cancer, so it is extremely important to seek medical assistance with your reflux before these further symptoms develop.

What causes reflux?

There are many causes of reflux including:

• Mechanical issues like a hiatus hernia (usually dealt with as part of the sleeve surgery or you would be encouraged to have a bypass rather than sleeve) or a stricture which can develop after a sleeve.
• Post op swelling early in the process. Reflux caused by swelling often subsides as you heal.
• The additional pressure placed on the stomach and oesophagus due to excess weight (it’s likely you would have had reflux prior to your sleeve if this is the case).
• Tating too fast, too much, taking mouthfuls that are too big or eating and drinking at the same time. These eating habits after the surgery often mean that food has difficulty making it into the stomach meaning the lower oesophageal sphincter has trouble closing as there is food in the way.

Common treatments for reflux after a sleeve

There are several common treatments but it’s most important to seek advice from your surgeon as they may wish to invesitgate the cause of your reflux with a Barium Swallow or endoscopy, as well as trial a variety of treatment options with you.

Medication. Most surgeons will prescribe prophylactic medication to prevent reflux initially after the surgery. For example, you might get told to take meds for the first month, then try to come of it – if you don’t get reflux you are often able to stop taking the medication. If reflux continues in the long term, your surgeon may trial different types of medication, dosages and timing to give you the best relief possible. For example, if you tend to get reflux at night, it might be worth trialling taking your medication in the evening instead of the morning, or your surgeon might recommend taking them morning and night to control symptoms.

Eating habits. To minimise the impact of eating habits on your reflux, it’s important to focus on how you are eating. If you find you get reflux after meals, no matter what you eat, make sure you:

• Slow down! Take 20-30 mins to eat, make sure your mouthfuls are small (1/2-1 teaspoon) and take breaks in between each mouthful.
• Watch your portion sizes. Stick to ~1 cup, but stop before that if you feel satisfied. Look for the ‘sigh moment‘ as a good indicator of when to stop
• Don’t eat and drink at the same time – leave 15-30 mins before and after meals to seperate drinking and eating.
• Don’t eat too late at night. Give your tummy at least 2 hours to digest before you lie down to sleep.
• Keep an eye out for ‘trigger foods’. Is there anything that tends to set off your reflux? If so, give it a break for a little while then try again – it might be a texture thing and after a bit more time, you might be able to manage. Common trigger foods tend to be heavy foods, rich foods or spicy foods, but this is different for everyone!

Other tips. A few other things might help too. Tor example:

• Sleep propped up on an extra pillow rather than lying flat
• Work on ways to manage your stress. Often when we are stressed, reflux is worse and we tend to find it hard to pay attention to how we eat which can trigger reflux.

Finally your surgeon may recommend revisional surgery if nothing else is doing a good job at managing your symptoms. Usually this will be conversion to a bypass, which minimises reflux post-op and can be recommended as a first option to someone who has GERD pre-op, too.