Already have GERD, need sleeve advice

[Briswife15 890]

My psychiatrist strongly discouraged me from bypass due to drug malabsorption issues. So now I'm leaning towards VSG. I have GERD which is fairly well controlled by taking a PPI and an acid reducer. Is there any way to predict if the sleeve will make my GERD unmanageable? I guess now my choices are sleeve or no surgery at all, and frankly for other health reasons, and being 110 lbs overweight, I need to have surgery!! Thanks!

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[Sosewsue61 3,185]

Have you had an EDG -esophagogastroduodenoscopy? That will show how much damage is present from gerd. I had a small amount but also had h pylori and was treated for that with 2 strong antibiotics. I have had minimal gerd and really just recently at 8 months out but handled with some meds.

[Briswife15 890]

Thanks for your reply. I had an upper endoscopy 2 years ago, but can't remember the results. I should try to get them from the doctor. I know I'm negative for H. Pylori. It is encouraging to me that you manage ok with meds.

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[S@ssen@ch 745]

I have had GERD off and on for my entire life. It seems to have "flare ups" depending on my diet, my weight, and my stress level. My doctor was comfortable doing the sleeve because he said my GERD was "situational" and the risk was low.

I wouldn't put much faith in the psych consult's opinion on what procedure you should have. Their job is to make sure you're mentally stable to handle bariatric surgery. Have a serious talk with your surgeon, weigh the pros and cons of the procedures, and decide TOGETHER which one is best for you.

Just a little info on my own terrible psych consult experience: My psych consult tried to dissuade me from the sleeve saying "I don't know if intractable GERD is worth the weight loss" and several other snide comments about obesity and bariatric surgery. The whole psych consult experience was a nightmare. She had me feeling worse about myself than I did walking in and had me convinced my 26 year marriage was completely dysfunctional.

There is no guarantee that with a history of GERD, that you will or will not develop it after sleeve. Some scientific studies say that there is a greater incidence of it with the sleeeve and other say it's negligible.

For example: I have a friend who had Barrett's esophagus from GERD. Had the sleeve and has had NO recurrence of GERD. Me, who seemed to have only occasional or "situational" GERD before the sleeve am developing a mild case of GERD.

[Briswife15 890]

Thanks, S@ssen@ch. I appreciate your advice. This wasn't my psych eval, though, but my personal psychiatrist who is worried about mental health flare ups from improperly absorbed psych meds after bypass. I see what you're saying, though. It should be a decision I make with the surgeon. It's just so confusing, and such a big decision!!

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[HopefullXOXOXO 73]

A psych consult is only as good as the psychiatrist is. Just saying. Mine also told me to ask about how meds would be metabolized after the sleeve. Surgeon said they're metabolized the same and that's been my experience, 10 weeks post op. My surgeon said it's different with bypass.

I've had GERD for years and had a big problem after surgery for a few weeks that was resolved by adding a second PPI daily. I stopped taking the second PPI abou 8 weeks post op because I was fine and I've been fine ever since. I am still following a GERD friendly diet (low acid) and that's it. It think it's different for everyone but this has been my experience. I also know someone who had the bypass and had problems with GERD post op for the first time. I was in a panic when I had the flare up not knowing what could be done. Just adding that 1 pill helped. The other thing is that I was taking a Multivitamin with Iron AND an iron pill. I believe that's what caused the heartburn/GERD. It's all trial and error.

[anonbaribabe 236]

47 minutes ago, S@ssen@ch said:

There is no guarantee that with a history of GERD, that you will or will not develop it after sleeve. Some scientific studies say that there is a greater incidence of it with the sleeeve and other say it's negligible.

This is what my doctor told me. I've also read that the development of GERD after surgery could be, in part, due to the surgeon's technique and that some patients' GERD gets better after losing weight.

[RickM 1,747]

If the GERD is a result of a hiatal hernia, not uncommon amongst the morbidly obese, then there is a good likelihood that it will be resolved when the hernia is repaired as part of the surgery.

Another option to consider is the DS, which typically uses a larger version of the sleeve, so GERD tends not to be as big of a problem as with the smaller VSG sleeve. It is a malabsorptive procedure, though of somewhat different character than the RNY so medication absorption is a consideration, but my wife is able to work through it with her DS and the various meds that she has to take.

In general, I would like to get a good handle on what is causing the GERD before getting into WLS, so that can be considered in weighing the options, as each procedure has its strengths and weaknesses.

[SouthernGirl76 74]

I had severe gerd before my sleeve I was on 2 PPIs and antiemetics. During my scope I wasn’t found to have a huge hernia (that somehow wasn’t missed by my GI doctor) I am 1 year post op and haven’t taken anything since.

[mgt3boys 24]

I had GERD prior to my surgery, during surgery they found a hernia, which I’ve kearned can cause acid reflux. It was repaired. 3 yrs post op had gall bladder taken out, hernia was back in same spot again. Both were dealt with surgically. 1 1/2 yrs after hernia repair it’s back again and so is my reflux. Not sure what I’m going to do but my dr has recommended a bypass. Just don’t know if I want to go that route.

Edited July 14, 2018 by mgt3boys