GERD/Acid Reflux - Reality vs Imagination

I agree with you, Grim.  Except, had I had a history of reflux of extensive PPI use, my surgeon would never have "allowed" me to have VSG.  We've talked about it.  In his practice, it would have been RNY or find another surgeon, thankyouverymuch.  He says the same thing to patients who have a hiatal hernia who don't want to repair it.  Find another surgeon.  He told me that he does far too many revisions, on patients referred from other surgeons who had GERD prior to surgery, that he'd rather err on the side of caution.  So while I agree the decision is ultimately the patients, the surgeons need to be more proactive about explaining the risks and real downsides and more involved in guiding the patient's choice.  (if that even makes sense)

I had Gerd b4 wls, but my gerd was very,very mild & likely caused by the hiatal hernia that was repaired at surgery. It was so mild that I hardly noticed it & only when I had the tests required by the surgeon/insurance that I even found out that I had it.

I was on a ppi for a couple of months b4 & after surgery & haven't needed it since, however I do know that Gerd is & will always be a risk post op.

Very happy with my sleeve. 

Anyone with a gastrectomy experiences discomfort for a few months, has issues with acid, digestion, etc., to varying degrees.  That is typical.  After a few months symptoms should reduce.  3+ months out if there are still severe symptoms it should be addressed.

GERD is complex and is not just due to acid overproduction; it's also a mechanical feature and dietary choices.  With Celiac you sometimes get GERD eating gluten for instance, and many people get GERD from lactose or are lactose intolerant, more so than we may think pre-op.  Also, acid under production can also cause reflux, which most are unaware of.

Typically if we have GERD pre-op while obese, I wonder if it isn't for the mechanical reasons.  If so, the sleeve may exacerbate it.  25% of patients develop GERD, on average (I forget the exact number), however it is also a confound that you can have "silent" reflux.  So some of that group - or most - possibly has silent GERD, as obesity puts tremendous strain on the stomach/esophageal opening.  It's, as others mentioned, a bad combo in general.

My GERD resolved to much advice here.  I eliminated dairy, got rid of crap coffee, tweaked a few other things.  I use far more probiotics.  I eliminate carbs as much as I can.  Carbs can ferment and cause gas/irritation, among other issues.

What I am getting at is I know you are upset, however discomfort is to be expected post-op.  The stomach is a tough organ, but surgery is still trauma - it's just purposeful trauma - and it takes time for things to re-regulate.

If you are in severe pain and your surgeon does nothing, call any general surgeon or get a referral to a GI.  They specialize in acid reflux and can provide a 2nd opinion.  

How much reflux is an issue?

I'm pre-op and it's been suggested that I'd be a good candidate for VSG, I've was asked at one of my appointments if I suffered with acid reflux, I replied that I probably suffered no more than anyone else but I'm starting to wonder if that was accurate. I probably have a bad bout every 6 to 8 weeks that lasts for a few hours, but when I was really stressed (like when I was doing my degree, and a single mum of 3) it was REALLY bad, but I put that down to the stress. At that time I was suffering for weeks on end and almost all day.

I've got a surgery info class tomorrow, I think I'll have to raise this with them but I'd like the views of people that have actually been through it.

If you've had any spells that bad, stress-related or not, I'd definitely suggest playing it safe and going for RNY instead of VSG. (But that's just my opinion, this is a great question for the class!)

As I stated in my reply above, I had issues with reflux pre-op.  But my medical team and I had other considerations that trumped that one.  I have been fine post-op, but granted I have to be on a PPI for my other meds anyway.

Ultimately, you and your medical team have to look at all of the risks and benefits and choose the best surgery for you.  There is almost never a hard and fast rule about anything in medicine because everyone is different and comes to the table with a different history and set of needs.

Acid is my one VSG side effect after surgery in 2006.  At this point I take 15 mg daily of Lanzaprole which has the same ingredient as prescription Prevaid and is much cheaper. https://www.amazon.com/s/re****c_1?rh=i%3Aaps%2Ck%3Alanzap role&keywords=lanzaprole&ie=UTF8&qid=1487066971

I never get acid reflux any more. Good luck finding what works for you.

I didn't have GERD before my sleeve surgery but I have it now if I don't take meds. Even with meds I get an episode every time I have a normal texture dense protein meal, even if I only eat 2 oz and was actually barfing  few times a week, so have been eating mostly cottage cheese, cashews, tuna and yogurt for about a week now. 

At my appointment today I was told to eat even slower, even if it takes me half an hour to eat a meal. I had two chicken wings tonight to try this out and it was tedious but better, though I  still felt queasy for about 10 minutes.

I've come to dread eating. 

AggieMae, do you regret your decision? How has your weight loss been?

I'm contemplating lap band to sleeve.

I'm going to throw out my own reflux experience to add to the experience info-base on this thread.  I'm not posting this to make the OP or anyone else think they're doing anything wrong -- but to show that WLS patients' GERD symptoms both pre- and post-WLS can vary considerably.  

I had VSG surgery at age 68.  I'm now 71.  It's been estimated that 60% of Americans over the age of 50 have a hiatal hernia.  And 40% of those under the age of 50 have a hiatal hernia.  Obviously, those folks suffer from varying degrees of a hernia and have differing degrees of dysfunction.  (And some folks are completely asymptomatic.)  

For 10-15 years prior to being sleeved I had mild GERD symptoms that were resolved by taking 150 mg. of Ranitidine (an H2 blocker, not a PPI) twice a day.  I also followed pretty well all the usual reflux-avoidance behaviors like not eating tomatoes + chocolate + alcohol + all the other reflux-inducing foods at the same time and in the evening.  And I was about 80-90% compliant with the most critial GERD-treatment instruction:  Remain upright after eating for at least two hours before going to bed at night.  

After VSG surgery my surgeon told me that he'd "repaired a small hiatal hernia."   

Like many VSG patients, I was prescribed a PPI (Protonix) post-op, which I took for 4 months.  After that I went back to my old Ranitidine Rx of 150 mg 2Xday.  I have also followed my old reflux-avoidance eating behaviors and have been even more compliant about those behaviors than I was pre-op.  

Today, 2.5 years post-VSG, I don't have any worse or more frequent GERD symptoms than I had pre-op.  By that, I mean that I seldom have any reflux symptoms that I can feel.  

A final thought for the OP -- obviously I don't know what's going on with your new sleeve.  But I do remember that in the first few months post-op, as my sleeve was healing and I was going through all the eating, behavioral, and mental adjustments we all go through post-sleeve, I experienced sensations that were temporary.  From that perspective, your body may be "going through a phase" of some kind that won't continue long-term as your sleeve continues to heal.  Looking back, it's very clear that how I felt and what I was experiencing a few months post-op was very different from how I have felt at various intervals since then.  

I'd love to hear how you're doing these days and what changes, if any, you and your surgeon have made in treating your GERD symptoms.