How significant is GERD in VSG and what causes it?

How common a problem is this for those who have had VSG surgery?

It seems to me that this would likely be due to eating too much at any one time resulting in your smaller stomach not being able to handle the volume of food going into it and then backing up into the bottom of your esophagus. If this is what's happening then it seems like it's something that could be pretty easily avoided by reducing your intake at any given time.

Or am I missing something?

I had pretty severe GERD before I had the sleeve done, so they just kept me on my pre-op Protonix, as well as adding some prilosec to the mix. I haven't had any real problems with GERD since the surgery.

I do know that it you overeat, and it only takes one bite when your stomach is so small, you will feel as though the food is backing up into your esophagus. The only advice I can give is to EAT SLOWLY and be mindful as to how full you are after each bite.

And, no, if you truly have GERD, the food could back up with ONLY 1 bite in your stomach. I know, I've had it happen (long before surgery).

If changing your eating habits could fix post-op GERD, we would see FAR fewer people being forced to have revisions because of acid problems.

It's not a behavior problem, it's a mechanical problem.

100% correct.

Hello- I never had any issues with Gerd prior to surgery. Following my VSG procedure I do have GERD 3-5x/ week. I personally am not a fan of Prilosec or Protonix due to recent research but, I do take Zantac as needed. I am hoping my GERD will resolve but we?ll see.

You're still very newly post-op. Most of us do have to take a PPI for the first 3-6 months post-op because our stomachs, initially, continue to produce the pre-VSG stomach acid amount which is, of course, way too much for our new, smaller stomachs! So you might consider taking something like Prilosec or Nexium, at least for a few months, and then tapering off it. Acid is no joke and can cause significant damage!

What have you discovered through your research?

Hello- recent research indicates that their is a positive correlation related to long term PPI usage and the development of cognitive diseases and also increased risk of developing CKD. Of course these findings are fairly new and additional studies are in progress- I personally prefer to use a H2 blocker but I'm sure they will have associated risks also!

It's unclear how prevalent it is DUE to VSG, because correlation does not equal causation. For example, I've got fructose malabsorption. If I eat something that's high in fructose, it leads to stomach acid. Is that due to VSG? Nope, since I had it prior to VSG. However, my stomach is now smaller so it's more noticeable post-VSG than it was prior. (And I do wonder how much of the time acid issues are related to unrealized food intolerances.)

What causes acid to be an issue? Boyle's Law. In a nutshell this means "decreased volume leads to increased pressure." When the stomach volume decreases, the increase in pressure can cause acid that was happily hanging out in your stomach to get pushed up into the esophagus. This isn't a problem with RNY because the valve/sphincter at the "bottom" of the stomach, the pyloric valve, is removed, so the RNY stomach is not the same high pressure environment as the VSG stomach is with it's intact pyloric valve.

It has nothing to do with volume of food.

Some people have pre-existing acid issues that are caused by hernia and this can be fixed during surgery. Some people have pre-existing acid issues for other reasons - dietary or whatever. Sometimes this continues to be a problem post-VSG. Sometimes it doesn't. Sadly, it's sort of a crapshoot.

I never had problems with acid prior to surgery, at least not that I was aware of. I rarely ingest(ed) high fructose things because of my fructose malabsorption. When I accidentally did it post-op and had the acid issue, it freaked me out until I figured out the cause! Due to my paranoia, I am considering asking my bariatric surgeon for an upper endoscopy at my 4 year follow-up next month. Just to make sure everything is okay in there.

All that said, if I had a history of acid issues prior to WLS and there wasn't an obvious cause such as hernia, I would get the RNY every day of the week and twice on Sunday. There's no way I'd even consider VSG.

Good explanation! I think another factor with the RNY is that the pouch is formed from the upper portion of the stomach, which usually doesn't produce as much acid. Is that correct?

Jen