Acid Reflux After Gastric Sleeve Surgery

Question Below Submitted By:  

Holly S. (a patient from Orwell, VT)

I had gastric sleeve surgery 16 months ago. I have had good weight loss success although my weight loss has stopped. I did lose all of the expected or projected weight from surgery.

I had problems with acid reflux before surgery so probably should of had gastric bypass in the first place. I now have a chronic cough, chest pain and burning in my throat.

Recent esophagrahm revealed reflux and a moderate size hiatal hernia. The hiatal hernia was NOT there before my gastric sleeve.

The question now is could just repairing the hiatal hernia fix the problem or should I have both hiatal hernia fixed and convert to the gastric bypass?

My surgeon is scaring me as he talks about how serious the bypass is. However, everything I’ve read says bypass is my best bet in this case. Wanting a second opinion.

I also have pain in my stomach under my sternum/rib cage along with chest pain and pain in my shoulder blade liked trapped air.

My Bariatric surgeon had me consult with hiatal hernia specialist. That specialist said my hiatal hernia isn’t big enough to cause those symptoms which I don’t understand if I’m having these symptoms. We have already ruled out heart issues. I have a pH probe test scheduled next week to see if the acid reflux is causing all of my symptoms as the recent endoscopy showed no esophagitis.

Again the barium swallow showed reflux halfway up. ENT exam showed no LPN however the burning I am feeling is in my throat. It is sore all the time and I have had a chronic cough for 5 months. Asthma was also ruled out.

Just looking for some answers that make sense and some reassurance if I do need to convert to bypass.

Thank you!


Expert Responses to the Question Above

Surgeon response to "Acid Reflux After Gastric Sleeve Surgery"

by: John Rabkin, MD


The reflux symptoms that you're experiencing are sometimes found after the Vertical Sleeve Gastrectomy (VSG). The "textbook" treatment for severe cases is to convert the VSG to a Roux-en-Y Gastric Bypass (RGB). This eliminates the "high pressure" of the sleeved stomach and minimizes any opportunity for the acid to reflux back up into your esophagous.

Your symptoms of coughing may represent chronic aspiration (inhalation of stomach contents) which can lead to chronic lung difficulties which certainly would be an indication to consider this treatment option.

However, many patients are reluctant to undergo this conversion as the RGB has its own set of problems and many patients are fearful of exchanging one set of problems for another.

Therefore, particularly as your endoscopy doesn't have evidence of dysplasia (pre-cancerous changes to the lining of your distal esophagous sometimes caused by severe reflux of stomach contents/acid), it may be reasonable to undergo an anti-reflux surgical procedure to see if that would adequately address your symptoms.

Unfortunately, the most effective of these types of procedures, the Nissen Fundoplication, isn't possible after the VSG due to the removal of the greater curvature of your stomach at the time of the VSG which would be needed to do that type of anti-reflux procedure.

Alternative procedures such as the Hill anti-reflux procedure, although less effective, may be an option for you. In addition, there are endoscopic anti-reflux procdures which haven't proven very effective in general but may be a consideration in your case.

Finally, there is a newer procdure called the LINX procedure which involves surgically placing a string of magnetic beads around the end of the esophagous to inhibit the reflux of the stomach contents back up into the esophagous which may hold promise for patients such as yourself.

It appears that you're under excellent medical care and that the physicians treating you are appropriately investigating your problem with the correct tests and advising you of your options. I'd listen carefully to their recommendations and enlist their assistance to help you make the proper decisions for your healthcare based on the best available information.

Best regards,

John Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:
- Gastric Sleeve Complications
- Comparing all Types of Weight Loss Surgery


Patient Responses to the Question Above


by: Tiffany

I'm in the same boat as you - yet I can't get into see the bariatric surgeon until March 8th. My cough is more noticeable after dinner and keeps me up at night. I too get the pains along with more vomiting recently. I have been having heartburn for a couple months which my Prilosec Rx isn't helping.

Do you have any updates on your treatment? Anything I can try? Hoping your feeling better.


by: Bonnie banks

Thank you so much for your story. I was researching because I thought gastric sleeve might help my reflux. Reflux is hell.

PH Monitor

by: Jena Lynn

I have gad chronic cough cough issues for over 5 years and have had almost every conceivable test done. No one can figure out if it is reflux or allergies. I have never heard of the pH test before.

Can you please let me know if it was definitive in determining if it was from reflux? All of my allergy test come back negative but I I am mostly convinced it is still something I am eating that has not shown results. Any help would be appreciated, thank you.

acid reflux constantly after sleeve

by: Louis J Gasbarri

What is the cure I have a 3 cm hernia in throat I was told not worry before the surgery.

Same issues

by: Magdalena Throckmorton

I have been having the same issues. Today went for a barium swallow study. I also have acid reflux and a hernia. See my Dr next month. I was told the only way to fix this now is for a bypass.


by: Kate

I was worried about my reflux before surgery and stressed this to my doctor. I wasn’t sure if it was a good idea. I was fine until end of month 2 now it’s ridiculous. I don’t know what to do, I’m sorry but bypass is not an option.

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