19 months out and still struggle with acid reflux

I developed severe reflux about 8 months after my VSG.  I had never had an issue with acid prior to my surgery.  After exhausting the PPIs that were available to me (Omeprazole, Protonix, Dexilant, Axid, Zantac), I revised to RNY.  After a mannometry test and 24 hr pH study as well as an EGD, it was determined that my acid was 409% higher than normal, that the acid was causing slight erosion of my esophagus as well as a significant issue with my ability to swallow (both my surgeon and my PCP told me the only way I was able to swallow was because of gravity and that I could not eat or drink anything in a position other than straight upright or I ran the risk of choking).  Since converting on 7/1 my acid has been under control and life is getting back to normal.  There was nothing short of revision that would work for me.  You may want to look into Stretta and see if it could help you.  We were considering it, but after my insurance company denied coverage, and my symptoms proved to be too severe, we decided to go forward with the revision.  Hope you find relief!

I never had acid reflux when I had the lapband.  After revision to the sleeve last November I developed acid reflux 2 days after surgery.  I take the Walmart brand of Prilosec and have been trying to wean from 1x a day to 1 every couple days.  There are times when I feel the acid but I think weaning is working.  Time will tell.

I had reflux before surgery but it seemed to get better for awhile although I have been taking something for acid almost the entire time since my surgery.  The past 3 nights I have woken up in the middle of the night and tonight I realized it is reflux waking me up.  The burning in my throat was unmistakeable.  I did eat something shortly before bed and I guess I am going to start trying a strict cut off time for food at night to see if that helps.  

I don't have the citation, but several studies indicate that between 20-27% of VSG patients wind up with GERD.  The smaller your sleeve the more likely it is that you will get it.  This is because the sleeve surgery changes the stomach into a high-pressure system.

I have lost 140 pounds since last August (I'm still about 150 pounds overweight) but have horrible GERD.  I also have Celiac and a hiatal hernia, so I am like, the GERD poster child for VSG patients right now.  I will have to revise my surgery eventually to something malabsorptive anyway.  I hope it's the DS versus the RNY depending on the cause of it, but I will do whatever I can to get rid of the GERD.

As for dealing with the GERD, Hala gave me a lot of good advice in another thread.  Many foods can exacerbate GERD.  In my case, wheat and dairy both cause it to be 5000x worse.  I have to have wheat daily for my EGD next week (ughhhh) and it's gotten so bad I now have constant pressure and pain even with 2x omeprazole.  So, it's definitely worth fining the cause.

Our sleeves are smaller than the DS'ers, but really not by much.  The difference between bougie sizes is less than a millimeter per size.  Having said that, there is a variant someone told me about where they do a small fundoplication that is still possible with some sleeves, but all of that depends on your size.

And Gwen is right - cancer is nothing to screw with.  We have a partial gastrectomy, but if it gets bad enough they may have to ultimately do a total gastrectomy/esophagogastrectmy.

But...yeah.  That GERD pain, though.  I am pretty much a pain badass.  I walk around with no pain killers and need two joint replacements.  The GERD pain?  Reduces me to a crying baby faster than this presidential election.  Seriously, it's horrible.

A typical DS sleeve will be about twice the size of what is usually used for a VSG - a 56-60 bougie is pretty common. My wife's stomach was 4 oz at time of surgery vs. mine at 2.5. Given our height difference, which typically correlates to stomach length, she would have had a 2 oz stomach if she had had a VSG sized stomach. Part of the GERD problem is the disproportionate reduction in acid production potential vs. the volume reduction (along with the higher pressure system with the intact pyloric valve,) which is why GERD is less of a problem overall in the DS population. Also, to the extent that bile reflux is a contributor to the problem, that is eliminated with the DS geometry (but can be more problematic with the RNY geometry.)

I never had reflux before surgery either, at least not that I recognized.  After surgery, HORRIBLE!  I'm almost 3-1/2 years out and just got off Protonix in January.  When you go off you have to expect rebound reflux for awhile.  I've discovered that I can't have anything acidic - no tomatoes, no spicy food - and I found that fried foods cause problems too.  I also took back diet soda for awhile and that didn't help things either.  

I still have to be super careful with the amount I eat, how fast I eat and make sure to not eat at least 2 hours before bed.  Oh, and I discovered my stomach does NOT like cold liquids - ever.  I have to drink warm or lukewarm, otherwise it's reflux city.  

So, there's hope - but you have to be super-committed, listen to your body and be willing to cut every single thing that is causing issues.  Even now I still have to take Tums for break-through acid.