Why Reflux Can Occur
Sleeve gastrectomy changes intragastric pressure and may alter the anti-reflux mechanism at the gastroesophageal junction. An undiagnosed hiatal hernia is an important contributor.
Initial Evaluation
Symptom pattern, response to acid-suppressing therapy, and — when persistent — upper endoscopy are key. pH monitoring and manometry are used in selected cases.
Conservative Management
Smaller, slower meals; avoid lying down for 2–3 hours after eating
Weight maintenance and avoiding tight clothing around the abdomen
Reducing trigger foods (very fatty, spicy, carbonated, alcoholic)
Proton pump inhibitor therapy under medical supervision
When Conversion Is Considered
Persistent, troublesome reflux despite optimised medical therapy — especially with oesophagitis, Barrett's oesophagus, or large hiatal hernia — may warrant evaluation for conversion to Roux-en-Y gastric bypass. Decisions are individualised.
References
- IFSO Consensus on Sleeve Gastrectomy and GERD
- Mechanick JI et al., 2019 Update
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