Overview
Heartburn, or acid reflux, occurs in approximately 20–40% of patients after sleeve gastrectomy — even those without preoperative GERD — and can persist long-term in up to 10% . It results from increased intragastric pressure and reduced lower esophageal sphincter (LES) function.
What Is Heartburn?
Heartburn is a burning sensation behind the breastbone caused by stomach acid moving up into the esophagus. Symptoms may include:
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Chest pain when bending or lying down
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Bitter or acidic taste at the back of the throat
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Difficulty swallowing or feeling of fullness
Why Sleeve Gastrectomy Increases Risk
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Increased Pressure: Sleeve creates a narrow gastric tube that elevates pressure in the stomach .
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LES Dysfunction: High pressure and tubular stomach may weaken LES, allowing acid reflux
- Pre-existing Conditions: Some patients already had reflux symptoms before surgery
Foods to Avoid
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Citrus fruits (orange, lemon), pineapple, kiwi
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Tomato products, onions, garlic, peppermint
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Chocolate, ice cream, egg yolk, pastries
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Fried/fatty foods, full-fat dairy
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Coffee, tea, carbonated drinks, spicy foods
Recommended Foods
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Carbohydrates: Rice, buckwheat, quinoa, oatmeal, boiled potatoes
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Veggies/Fruits: Non-acidic options like bananas, melons, apples (monitor personally)
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Protein: Lean meats (chicken, fish), low-fat cheese/yogurt, legumes, tofu
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Fats: Nuts (soaked overnight), small amounts of olive oil, avocado
Eating Habits
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Eat smaller, frequent meals to avoid overstretching the sleeve –
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Do not lie down or bend forward for at least 2–3 hours after eating
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Avoid eating just before bedtime; elevate the head of your bed if reflux occurs at night .
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Keep a food diary to track triggers and symptoms
Medications & Clinical Options
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Over-the-counter antacids can temporarily neutralize stomach acid.
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Proton pump inhibitors (PPIs) or H2 blockers (prescription-strength) reduce acid production
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For persistent or severe reflux, consult your bariatric team to explore:
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Conversion to gastric bypass, which alleviates reflux by diverting bile and lowering pressure
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LINX device (magnetic sphincter augmentation) to strengthen the LES
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When to Seek Medical Attention
Seek professional evaluation if you experience:
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Persistent heartburn despite lifestyle and dietary modifications
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Symptoms of GERD (e.g. chronic regurgitation, throat irritation)
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Esophagitis or difficulty swallowing
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Potential complications like hiatal hernia
A recent review shows significant GERD reduction when a hiatal hernia is repaired during sleeve surgery If reflux continues, conversion to a bypass might be the best option
Summary & Action Plan
| Area | Action |
|---|---|
| Diet | Eliminate acid triggers; choose low-fat, non-acidic foods |
| Portion Control | Eat smaller amounts, slower |
| Post-Meal Behavior | Stay upright, avoid lying down for ≥2–3h |
| Nighttime | Don’t eat before bed; elevate head of bed |
| Medication | Use antacids / PPIs as needed |
| Medical Follow‑Up | Consider revisional procedures if needed |
