Reflux and Sleeve?

[sdocforce 55]

For those that are a little further out...just wondering...I don't suppose the reflux gets better over time?? I was religiously taking pepcid twice daily, but then at about 4.5-5 months out that wasn't cutting it. I had to add Omeprazole too. I knew that the Sleeve would likely result in reflux, but I'm a little concerned that it takes two classes of medication to keep it under control at 5 mos, where do I go from here?

thanks for your input...

[Schmincke 118]

It may not be reassuring but here are two very recent abstracts on the topic, suggesting that worsening of reflux is very common unless there is hiatal hernia repair performed too. The first abstract simply reflects the experience at one newly-opened center so its results may have more complications than would be seen with very experienced surgeons, especially at a Bariatric Center of Excellence:

BMC Surg. 2014 Feb 11;14(1):8. doi: 10.1186/1471-2482-14-8.

Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study.

Våge V1, Sande VA, Mellgren G, Laukeland C, Behme J, Andersen JR.

Abstract

BACKGROUND:

To evaluate changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG).

METHODS:

We started the procedure in May 2007, and by December 2011, 117 patients could be evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients.

RESULTS:

Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomaticgastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively.

CONCLUSIONS:

LSG is an effective procedure for morbid obesity and obesity-related diseases, but the technique should be further explored particularly to avoid gastroesophageal reflux. Free PMC Article

Expert Rev Gastroenterol Hepatol. 2014 Mar 3. [Epub ahead of print]

The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility.

Hayat JO1, Wan A.

Abstract

Sleeve gastrectomy is an increasingly performed bariatric procedure associated with low morbidity and good short to medium term effects on weight loss and comorbid conditions. Studies assessing the prevalence of post-operative gastro-esophageal reflux disease (GERD), show sleevegastrectomy may provoke de novo GERD symptoms or worsening of pre-existing GERD. Pathophysiological mechanisms of GERD after sleevegastrectomy include a hypotensive lower esophageal sphincter, increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach. A reduction in the compliance of the gastric remnant may provoke an increase in transient lower esophageal sphincter relaxations. Time-resolved MRI suggests relative gastric stasis in the proximal remnant and increased emptying from the antrum. A lack of standardisation of technique, along with heterogeneity of studies assessing GERD may explain the wide variability in reported results. Simultaneous and careful repair of an associated hiatus hernia may result in a reduction in the prevalence of post-operative GERD.

Edited March 4, 2014 by Schmincke

[marfar7 1,533]

I take Rx Prilosec (40mg 2x a day) and OTC Zantac to keep my reflux under control. At times I've tried to lower my dosage but I wake up with either heartburn or reflux.

Guess I'll be on them forever. Small price to pay to combat obesity...good luck...

[ASKSARAH - Sleeve 256]

I was taking 3 different kinds at first trying to find one that works for me and I finally found zantex OTC.

It works immediately and over 24 hours. I do not take it daily. Haven't really ever. The less I take it the less I need it. If I lay on my left side I need it at night I notice, so I do not lay that way.

I am a little over a year out and I need them about 1x a week.