True Scientifically well supported Certainty of evidence: high provisional C-BAR-02

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

In short: This claim is correct: randomised trials and meta-analyses consistently show more reflux, more acid-suppressant use and more oesophagitis after sleeve gastrectomy, although severe oesophagitis is uncommon (about 3%).

Conclusion: Correct: sleeve gastrectomy clearly increases reflux and oesophagitis.

Original statement
Scientific assessment
Scientific evidence in detail
In plain language
Studies on this claim
Regional context
What applies in my country?
References

Original statement

ومع إن التكميم على عملية وحشة جدا ونتائجها وحشة جدا ومن أهم مضاعفاتها إنها بتزود ارتجاع المريء

verbatim according to source. Translation by the project; the Arabic wording is authoritative.

Translation

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Origin

Source status: Video transcript (own words)
Attribution: Elawady (machine transcript)
Video: عمليات السمنة ايه افضل عملية لصحتك وبدون خطورة (Open source)
Published: 31 March 2021
Timestamp: 0:00:31 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
Attribution uncertainty: Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available. This 2021 transcript contains embedded time markers (approx. [00:29]); they come from the archive transcript, not from this project.

Claimed mechanism: Cutting the stomach into a tube raises intragastric pressure and changes the oesophagogastric junction.
Claimed health effect: Chronic acid reflux, oesophagitis.
Population concerned: Sleeve gastrectomy patients
Geographic restriction by Elawady: none found

Diverging source versions

Source status: Archive editors
Attribution: Archive editors (eltayebat.com); not necessarily Elawady's own words
Origin: https://eltayebat.com/rule/bariatric-surgery/
Attribution uncertainty: Editorial summary/narrative and study selection written by the archive operators; the archive states that the cited research documents harm independently of Dr. Diaa's words.

Scientific assessment

True – The statement is supported by robust evidence.

Certainty of evidence: high – Further research is very unlikely to change the assessment.

1. What was claimed?

That sleeve increases reflux.

2. What is demonstrably correct?

Correct: esophagitis 31% after sleeve vs 7% after bypass at 10 years (SLEEVEPASS); reflux worsened in 31.8% vs 6.3% (SM-BOSS); pooled RR for GERD symptoms 3.32 and PPI use 3.65 after sleeve (Chandan 2025).

3. What is wrong or exaggerated?

Nothing substantial in this sub-claim.

4. What remains unclear?

Long-term clinical consequences (cancer) remain uncertain. Severe (grade C/D) oesophagitis is uncommon (about 3%, I-BAR-111), and one RCT (Oseberg, I-BAR-116) found more pathological acid reflux but similar erosive oesophagitis after sleeve vs bypass at 5 years.

5. Which studies support it?

A-BAR-07, A-BAR-08, A-BAR-09, I-BAR-04, I-BAR-05; new: SM-BOSS 10-year (I-BAR-142: more de novo GERD; conversions 29.9% vs 5.5%), meta-analyses I-BAR-109 (de novo reflux 23%, oesophagitis 28%) and I-BAR-112 (GERD 35%), Danish national data (I-BAR-144: GERD diagnosis HR 1.93 vs bypass), and the international consensus I-BAR-113 calling GERD the main drawback of sleeve.

6. Which studies contradict it?

None identified for the direction of effect.

7. What applies to Germany and Europe?

Most key data are European (Sweden SOS/SOReg, Finland SLEEVEPASS, Switzerland SM-BOSS). European and international society guidelines consider bariatric surgery for severe obesity with lifelong follow-up.

8. What is known about Egypt?

No Egypt-specific outcome data were identified in this review. Elawady states in a transcript that sleeve gastrectomy is very widely performed in Egypt ('مصر كلها بتعملها'); the procedure-specific risks (reflux, deficiencies) apply wherever it is performed, and follow-up quality (supplements, endoscopy, mental-health screening) determines part of the risk.

9. What practical conclusion is appropriate?

Reflux is a well-documented, frequent downside of sleeve gastrectomy; bypass is usually preferred when significant reflux exists.

Assessment details

Rationale for certainty of evidence: Two RCTs (SLEEVEPASS, SM-BOSS) and a meta-analysis consistently show more reflux/oesophagitis after sleeve than after bypass or before surgery.
Source quality: Randomized trials plus meta-analysis.
Regional transferability: European RCTs; directly transferable.
Individual exceptions: Some patients have less reflux after sleeve (SM-BOSS: 25% remission); pre-existing reflux and hiatal hernia increase risk.
Regional scope of the claim: general (biological/medical)
Last reviewed: 26 October 2026 provisional

Scientific evidence in detail

Scientifically well supported – The claim agrees with consistent, high-quality evidence.

Research question: Does sleeve gastrectomy increase gastro-oesophageal reflux disease and erosive oesophagitis compared with the preoperative state and with gastric bypass?

Research question in detail (PICO)

Population

Adults undergoing sleeve gastrectomy

Intervention or exposure

Sleeve gastrectomy

Comparison

Preoperative status; Roux-en-Y gastric bypass

Geographic scope

universal biology (anatomical effect of the operation)

Outcomes

GERD symptoms/diagnosis
Erosive oesophagitis
PPI use
Conversion for reflux

Study results as reported by the authors. Our assessment follows below.

What speaks for the claim?

Finnish trial: sleeve vs bypass after 10 years

Salminen P et al.. JAMA Surg 2022 · PMID 35731535 · DOI 10.1001/jamasurg.2022.2229 Randomised controlled trialabstract checked

SLEEVEPASS RCT: oesophagitis at 10 years far more frequent after sleeve than bypass.

Actual result
Oesophagitis 31% vs 7% (P<.001).
Methodological quality
high (RCT)
Relevance
direct
Limitations
Attrition; comparison with bypass, not with no surgery

Original publication
Swiss trial: sleeve vs bypass after 10 years

Kraljevic et al.. JAMA Surg 2025 · PMID 39969869 · DOI 10.1001/jamasurg.2024.7052 Randomised controlled trialabstract checkednewly added

SM-BOSS RCT >=10 y: more de novo GERD and many more conversions after sleeve.

Actual result
Conversions 29.9% vs 5.5%; de novo GERD higher after SG (P=.02).
Methodological quality
high (RCT, 65% complete follow-up)
Relevance
direct
Limitations
Attrition

Original publication
Meta-analysis: Barrett's after sleeve

Chandan S et al.. Clin Gastroenterol Hepatol 2025 · PMID 39059544 · DOI 10.1016/j.cgh.2024.06.041 Meta-analysisabstract checked

Meta-analysis of long-term studies: GERD symptoms, oesophagitis and PPI use about three times more frequent after sleeve than before.

Actual result
Erosive oesophagitis RR 3.37; GERD symptoms RR 3.32; PPI RR 3.65.
Methodological quality
moderate
Relevance
direct
Limitations
Pre-post observational

Original publication

What speaks against the claim?

Norwegian trial: bypass vs sleeve in type 2 diabetes

Wågen Hauge et al.. Lancet Diabetes Endocrinol 2025 · PMID 40185112 · DOI 10.1016/S2213-8587(24)00396-6 Randomised controlled trialabstract checkednewly added

Oseberg RCT: pathological acid reflux much more frequent after sleeve, but erosive oesophagitis prevalence similar to bypass at 5 years.

Actual result
Pathological acid reflux RD 51.1% (28.0-74.2); erosive oesophagitis similar.
Methodological quality
high but small
Relevance
direct - limits only the oesophagitis part
Limitations
n=109, secondary outcome

Original publication
How often severe gullet inflammation follows sleeve

Alqasem et al.. Obes Surg 2026 · PMID 41964778 · DOI 10.1007/s11695-026-08605-5 Meta-analysisabstract checkednewly added

Severe (LA C/D) oesophagitis after sleeve is uncommon.

Actual result
Pooled 3% (2-6%).
Methodological quality
moderate
Relevance
direct for severity
Limitations
Observational

Original publication

What does the overall evidence say?

Editorial assessment based on the studies above – not itself a study result.

Which position is better supported?

Sleeve gastrectomy clearly increases reflux and acid-suppressant use and increases oesophagitis in most data; severe oesophagitis is uncommon.

Why some studies weigh more

Two European RCTs with >=10-y follow-up (SLEEVEPASS, SM-BOSS) and consistent meta-analyses weigh most; Oseberg adds nuance on oesophagitis severity.

Is a causal relationship established? Yes, established Randomised comparisons and plausible mechanism (high intragastric pressure, altered angle of His, hiatal hernia).

Remaining uncertainty

Long-term consequences (Barrett, cancer); size of oesophagitis excess vs bypass differs between trials.

Justified conclusion

The claim is correct.

Why do studies seem to disagree?

SLEEVEPASS found much more oesophagitis after sleeve, whereas Oseberg found similar oesophagitis but more pathological acid reflux; differences in follow-up (10 vs 5 y), endoscopy protocols, sample size and banded vs non-banded bypass likely explain this. Both confirm more reflux after sleeve.

Does this depend on the country?

General biological effects: Anatomical effect; universal.
Eating habits: Not applicable (surgical procedure, not a food).
Origin of the food: Not applicable (surgical procedure, not a food).
Contaminants: Not applicable (surgical procedure, not a food).
National production conditions: Surgical technique (hiatal hernia repair, sleeve shape) varies between centres.
Legal rules: Not applicable.
Actual monitoring data: No Egyptian national bariatric registry data were found; one Egyptian single-surgeon series (I-BAR-105) and one Egyptian RCT (I-BAR-136) were identified.

A regional difference that changes the conclusion is not supported by robust data.

Statistical re-check

Reproduce risk differences from counts – Diabetes remission RDs reproduced exactly (29.5%, 33.5%); reflux RD not recalculable (counts not in abstract). recalculated
Detection bias between prospective and retrospective studies – Prospective 7% vs retrospective 2%: systematic endoscopy finds more severe oesophagitis; true value likely between. not recalculable from the published data

Certainty of the overall evidence (GRADE, simplified)

Main outcome

GERD/oesophagitis after sleeve vs bypass or baseline

Starting level

high (randomised trials)

Reasons for downgrading

none (minor attrition)

Result

high

Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.

Clinical guidelines and official statements checked

International expert consensus (Montpellier): GERD and LSG: First International Consensus Conference (I-BAR-113) (2020) · Original publication
GERD is probably the main drawback of LSG; endoscopy before (92%) and after (78%) surgery; higher-grade oesophagitis and Barrett are contraindications to LSG; RYGB recommended for uncontrolled GERD after sleeve.
IFSO: Position Statement on Upper GI Endoscopy Before and After MBS (I-BAR-114) (2025) · Original publication
Barrett incidence after MBS estimated at 2.4% (very heterogeneous, high likelihood of bias, little follow-up beyond 2 years); seven recommendations on endoscopy before/after MBS (recommendation text not in abstract, not used).
ASMBS/IFSO: 2022 ASMBS and IFSO Indications for Metabolic and Bariatric Surgery (I-BAR-11) (2022) · Original publication
Metabolic and bariatric surgery is recommended for BMI >35 regardless of comorbidities and should be considered for BMI 30-34.9 with metabolic disease; long-term results consistently demonstrate safety and efficacy (abstract; erratum noted in PubMed).

Search strategy

Documented literature searches for this review (search strings in the original database syntax).

Database	Date	Search	Looking for	Hits
Europe PMC	26 October 2026	`TITLE:"sleeve gastrectomy" AND (TITLE:"reflux" OR TITLE:"GERD" OR TITLE:"esophagitis" OR TITLE:"Barrett") AND (PUB_TYPE:"Meta-Analysis" OR TITLE:"meta-analysis")`	supporting evidence	24
PubMed	26 October 2026	`(sleeve gastrectomy[ti]) AND (gastroesophageal reflux[tiab] OR GERD[tiab]) AND (de novo[tiab]) AND (systematic review[pt] OR meta-analysis[pt] OR randomized controlled trial[pt])`	supporting evidence	22
PubMed	26 October 2026	`(sleeve gastrectomy[ti]) AND (reflux[ti] OR GERD[ti]) AND (resolution[ti] OR remission[ti] OR improvement[ti] OR improves[ti] OR decrease*[ti])`	contradicting evidence	21
Europe PMC	26 October 2026	`TITLE:"sleeve gastrectomy" AND (TITLE:"reflux" OR TITLE:"GERD") AND (TITLE:"improve" OR TITLE:"resolution" OR TITLE:"remission" OR TITLE:"decrease") AND PUB_YEAR:[2018 TO 2026]`	contradicting evidence	15
Europe PMC	26 October 2026	`(TITLE:"gastroesophageal reflux" OR TITLE:"GERD" OR TITLE:"reflux") AND (TITLE:"sleeve") AND (TITLE:"statement" OR TITLE:"consensus" OR TITLE:"guideline" OR TITLE:"position")`	guidelines	5
Europe PMC	26 October 2026	`AFF:"Egypt" AND TITLE:"sleeve gastrectomy" AND (TITLE:"reflux" OR TITLE:"GERD" OR TITLE:"esophagitis" OR TITLE:"Barrett") AND (TITLE:"randomized" OR TITLE:"randomised" OR TITLE:"prospective" OR TITLE:"long-term")`	both directions	3

Open questions

Whether newer techniques (fundoplication-sleeve, hiatal repair) remove the excess.

How deeply was this checked?

12 linked studies: 0 checked in full text (0 of them with a structured risk-of-bias assessment), 12 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.

Last scientific review: 26 October 2026

History of the verdict

25 October 2026 · Phase 1 · Initial assessment: True (high)
26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: True (high)
Verdict “True” and certainty high unchanged; new 10-year SM-BOSS data and meta-analyses confirm it. Oseberg shows oesophagitis excess is not found in every trial, which is mentioned as nuance but does not change the verdict.
New sources: I-BAR-109 I-BAR-112 I-BAR-113 I-BAR-142 I-BAR-144 I-BAR-111 I-BAR-116

In plain language

Elawady said sleeve gastrectomy increases acid reflux. This is correct. In Finnish and Swiss randomized trials, reflux and inflammation of the gullet were several times more frequent after sleeve than after gastric bypass. Many sleeve patients need acid-reducing drugs. Doctors therefore often choose a bypass for people who already have reflux.

Studies on this claim

Studies supporting the claim (10)

Finnish trial: sleeve vs bypass after 10 years

Salminen P et al.. JAMA Surg 2022 · PMID 35731535 · DOI 10.1001/jamasurg.2022.2229

Randomised controlled trialcited by the Tayebat archiveabstract checked★ key study

Esophagitis was found in 31% after sleeve vs 7% after bypass; Barrett's esophagus was 4% in both groups.

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Compare sleeve vs bypass
How was the study done?
RCT with 10-year follow-up
How many people, animals or samples were studied?
240 patients
What was actually found?
More esophagitis after sleeve; Barrett's equal
How large was the observed effect?
31% vs 7%; BE 4% vs 4%
What do the results mean in everyday life?
Sleeve often causes reflux damage; bypass less so
What are the study's limitations?
Attrition; small
What does it say about Elawady's specific claim?
Supports reflux claim, not sleeve-specific Barrett's
Do the results apply to Germany and Europe?
Directly European
What can explicitly not be concluded from this study?
Cancer risk
Scientific details →
Austrian follow-up 10+ years after sleeve

Felsenreich DM et al.. Obes Surg 2017 · PMID 28593484 · DOI 10.1007/s11695-017-2748-9

Case series / case reportcited by the Tayebat archiveabstract checked

Many patients had reflux and 15% had Barrett's changes, but the study was very small.

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Long-term reflux
How was the study done?
Case series
How many people, animals or samples were studied?
43
What was actually found?
High BE rate
How large was the observed effect?
15%
What do the results mean in everyday life?
Signal of concern
What are the study's limitations?
Small, early technique
What does it say about Elawady's specific claim?
Partly supports
Do the results apply to Germany and Europe?
European
What can explicitly not be concluded from this study?
True incidence
Scientific details →
Endoscopy 5+ years after sleeve

Sebastianelli L et al.. Obes Surg 2019 · PMID 30666544 · DOI 10.1007/s11695-019-03704-y

Cross-sectional studycited by the Tayebat archiveabstract checked

About 1 in 5 had Barrett's changes; reflux symptoms rose from 22% to 76%.

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Prevalence
How was the study done?
Cross-sectional
How many people, animals or samples were studied?
90
What was actually found?
High BE and GERD
How large was the observed effect?
BE 18.8%
What do the results mean in everyday life?
Reflux is frequent after sleeve
What are the study's limitations?
Small, no control
What does it say about Elawady's specific claim?
Supports reflux claim
Do the results apply to Germany and Europe?
European
What can explicitly not be concluded from this study?
Exact risk
Scientific details →
Meta-analysis: Barrett's after sleeve

Chandan S et al.. Clin Gastroenterol Hepatol 2025 · PMID 39059544 · DOI 10.1016/j.cgh.2024.06.041

Meta-analysisindependent cross-checkabstract checked★ key study

About 5.6% developed new Barrett's esophagus; reflux and acid-medication use were about 3 times more frequent after sleeve.

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
BE after SG
How was the study done?
Meta-analysis
How many people, animals or samples were studied?
2046
What was actually found?
BE 5.6%; GERD x3
How large was the observed effect?
RR GERD 3.32
What do the results mean in everyday life?
Reflux is a major downside of sleeve
What are the study's limitations?
Heterogeneous observational
What does it say about Elawady's specific claim?
Supports reflux/BE claim, not 'inevitable'
Do the results apply to Germany and Europe?
Applicable
What can explicitly not be concluded from this study?
Cancer risk
Scientific details →
Swiss trial: sleeve vs bypass

Peterli R et al.. JAMA 2018 · PMID 29340679 · DOI 10.1001/jama.2017.20897

Randomised controlled trialindependent cross-checkabstract checked★ key study

Reflux got worse in about 32% after sleeve vs 6% after bypass.

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Compare procedures
How was the study done?
RCT
How many people, animals or samples were studied?
217
What was actually found?
More reflux after sleeve
How large was the observed effect?
31.8% vs 6.3%
What do the results mean in everyday life?
Reflux is common but not universal
What are the study's limitations?
Exploratory reflux outcome
What does it say about Elawady's specific claim?
Supports increase, refutes 'inevitable'
Do the results apply to Germany and Europe?
European
What can explicitly not be concluded from this study?
Long-term BE
Scientific details →
Meta-analysis: reflux after sleeve

Yeung et al.. Ann Surg 2020 · PMID 30921053 · DOI 10.1097/SLA.0000000000003275

Meta-analysisindependent cross-checkabstract checked★ key study

About 23 in 100 developed new reflux after sleeve, 28 in 100 had oesophagitis at long-term endoscopy, and 4 in 100 needed a second operation for reflux.

De novo reflux 23%, oesophagitis 28%.

Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Estimate reflux after sleeve
How was the study done?
Meta-analysis
How many people, animals or samples were studied?
10,718 patients
What was actually found?
De novo reflux 23%; oesophagitis 28%; Barrett 8%
How large was the observed effect?
Proportions
What do the results mean in everyday life?
Reflux is a frequent downside, not universal
What are the study's limitations?
Heterogeneous, uncontrolled
What does it say about Elawady's specific claim?
Supports "increases reflux"; contradicts "inevitable"
Do the results apply to Germany and Europe?
Applicable
What can explicitly not be concluded from this study?
Cancer risk
Scientific details →
How often reflux disease develops after sleeve

Trujillo et al.. Obes Surg 2024 · PMID 38483740 · DOI 10.1007/s11695-024-07163-y

Meta-analysisindependent cross-checkabstract checked

About 1 in 3 patients developed reflux disease after sleeve (about 6 in 10 in trials with systematic testing).

Pooled GERD after LSG 35%.

Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Incidence of GERD after LSG
How was the study done?
Meta-analysis
How many people, animals or samples were studied?
20,495
What was actually found?
35% overall
How large was the observed effect?
Proportion 0.35
What do the results mean in everyday life?
Reflux is common
What are the study's limitations?
Very heterogeneous
What does it say about Elawady's specific claim?
Supports reflux claim; not "inevitable"
Do the results apply to Germany and Europe?
Applicable
What can explicitly not be concluded from this study?
Severity
Scientific details →
International experts on reflux and sleeve

Assalia et al.. Obes Surg 2020 · PMID 32533520 · DOI 10.1007/s11695-020-04749-0

Guideline / position statementindependent cross-checkabstract checked

Experts agreed that reflux is probably the main drawback of sleeve and that bypass is preferable when severe reflux exists.

Experts call GERD the main drawback of LSG.

Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Agree on GERD management
How was the study done?
Expert consensus
How many people, animals or samples were studied?
46 experts
What was actually found?
Endoscopy before/after; bypass for severe GERD
How large was the observed effect?
Agreement %
What do the results mean in everyday life?
Doctors take reflux after sleeve seriously
What are the study's limitations?
Opinion-based
What does it say about Elawady's specific claim?
Supports reflux concern
Do the results apply to Germany and Europe?
International
What can explicitly not be concluded from this study?
Does not condemn sleeve generally
Scientific details →
Swiss trial: sleeve vs bypass after 10 years

Kraljevic et al.. JAMA Surg 2025 · PMID 39969869 · DOI 10.1001/jamasurg.2024.7052

Randomised controlled trialindependent cross-checkabstract checked★ key study

After more than 10 years, 3 in 10 sleeve patients needed a conversion operation (for reflux or weight) vs about 1 in 20 after bypass; new reflux was more common after sleeve.

More de novo GERD after SG at >=10 y (RCT).

Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Compare long-term SG and RYGB
How was the study done?
RCT
How many people, animals or samples were studied?
217
What was actually found?
More conversions and de novo GERD after SG
How large was the observed effect?
29.9% vs 5.5% conversions
What do the results mean in everyday life?
Sleeve has more long-term reflux problems
What are the study's limitations?
Attrition
What does it say about Elawady's specific claim?
Supports reflux and bypass-preference parts
Do the results apply to Germany and Europe?
Directly European
What can explicitly not be concluded from this study?
Mortality differences
Scientific details →
Danish study: acid medicines after sleeve vs bypass

Gormsen et al.. Int J Obes (Lond) 2024 · PMID 39043831 · DOI 10.1038/s41366-024-01593-5

Cohort studyindependent cross-checkabstract checked

Sleeve patients were much more likely to start acid-reducing medicines and to keep taking them than bypass patients.

GERD diagnosis HR 1.93 vs RYGB.

Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
PPI use after SG vs RYGB
How was the study done?
National cohort
How many people, animals or samples were studied?
17,740
What was actually found?
More PPI use after SG
How large was the observed effect?
HR 7.06
What do the results mean in everyday life?
Many sleeve patients need acid medicines
What are the study's limitations?
Small SG group
What does it say about Elawady's specific claim?
Partly supports
Do the results apply to Germany and Europe?
Directly European
What can explicitly not be concluded from this study?
Lifelong need for all
Scientific details →

Studies contradicting or limiting the claim (0)

No studies in this group.

Studies with mixed or unclear results (2)

How often severe gullet inflammation follows sleeve

Alqasem et al.. Obes Surg 2026 · PMID 41964778 · DOI 10.1007/s11695-026-08605-5

Meta-analysisindependent cross-checkabstract checked

About 3 in 100 sleeve patients had severe inflammation of the gullet at endoscopy.

Confirms GERD frequent; severe EE uncommon.

Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Severe oesophagitis after SG
How was the study done?
Meta-analysis
How many people, animals or samples were studied?
1,587
What was actually found?
3% (7% in prospective studies)
How large was the observed effect?
Proportion
What do the results mean in everyday life?
Severe damage is uncommon
What are the study's limitations?
Small, observational
What does it say about Elawady's specific claim?
Limits "inevitable" framing
Do the results apply to Germany and Europe?
Applicable
What can explicitly not be concluded from this study?
Cancer risk
Scientific details →
Norwegian trial: bypass vs sleeve in type 2 diabetes

Wågen Hauge et al.. Lancet Diabetes Endocrinol 2025 · PMID 40185112 · DOI 10.1016/S2213-8587(24)00396-6

Randomised controlled trialindependent cross-checkabstract checked★ key study

After 5 years, diabetes was in remission in 50% after bypass vs 20% after sleeve; acid reflux was more common after sleeve, but Barrett changes were similar.

Pathological acid reflux more after SG; erosive oesophagitis similar to bypass.

Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

Original publication · Scientific details

Study explained simply
What did the researchers want to find out?
Compare RYGB and SG in T2D
How was the study done?
Randomised trial
How many people, animals or samples were studied?
109
What was actually found?
Bypass better for remission and weight; sleeve more acid reflux
How large was the observed effect?
RD 29.5%
What do the results mean in everyday life?
Bypass helps diabetes more but is not a cure
What are the study's limitations?
Small, single centre
What does it say about Elawady's specific claim?
Supports bypass preference for diabetes/reflux; contradicts "complete cure"
Do the results apply to Germany and Europe?
Directly European
What can explicitly not be concluded from this study?
Long-term hard outcomes
Scientific details →

Regional context

Germany / EU

Egypt

What applies in my country?

General scientific assessment

True Correct: sleeve gastrectomy clearly increases reflux and oesophagitis.

This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.

References

Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial.. Salminen P et al.. JAMA Surg 2022 · PMID 35731535 · DOI 10.1001/jamasurg.2022.2229
Reflux, Sleeve Dilation, and Barrett's Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up.. Felsenreich DM et al.. Obes Surg 2017 · PMID 28593484 · DOI 10.1007/s11695-017-2748-9
Systematic Endoscopy 5 Years After Sleeve Gastrectomy Results in a High Rate of Barrett's Esophagus: Results of a Multicenter Study.. Sebastianelli L et al.. Obes Surg 2019 · PMID 30666544 · DOI 10.1007/s11695-019-03704-y
Risk of De Novo Barrett's Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Studies With Long-Term Follow-Up.. Chandan S et al.. Clin Gastroenterol Hepatol 2025 · PMID 39059544 · DOI 10.1016/j.cgh.2024.06.041
Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.. Peterli R et al.. JAMA 2018 · PMID 29340679 · DOI 10.1001/jama.2017.20897
Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis.. Yeung et al.. Ann Surg 2020 · PMID 30921053 · DOI 10.1097/SLA.0000000000003275
Incidence of Post-operative Gastro-esophageal Reflux Disorder in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis.. Trujillo et al.. Obes Surg 2024 · PMID 38483740 · DOI 10.1007/s11695-024-07163-y
Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference.. Assalia et al.. Obes Surg 2020 · PMID 32533520 · DOI 10.1007/s11695-020-04749-0
Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity: The SM-BOSS Randomized Clinical Trial.. Kraljevic et al.. JAMA Surg 2025 · PMID 39969869 · DOI 10.1001/jamasurg.2024.7052
Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy: a nationwide register-based cohort study.. Gormsen et al.. Int J Obes (Lond) 2024 · PMID 39043831 · DOI 10.1038/s41366-024-01593-5
Prevalence of Severe Erosive Esophagitis After Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.. Alqasem et al.. Obes Surg 2026 · PMID 41964778 · DOI 10.1007/s11695-026-08605-5
Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial.. Wågen Hauge et al.. Lancet Diabetes Endocrinol 2025 · PMID 40185112 · DOI 10.1016/S2213-8587(24)00396-6

← Back to overview

Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis.

Original statement

Translation

Origin

Diverging source versions

Scientific assessment

1. What was claimed?

2. What is demonstrably correct?

3. What is wrong or exaggerated?

4. What remains unclear?

5. Which studies support it?

6. Which studies contradict it?

7. What applies to Germany and Europe?

8. What is known about Egypt?

9. What practical conclusion is appropriate?

Assessment details

Scientific evidence in detail

What speaks for the claim?

Finnish trial: sleeve vs bypass after 10 years

Swiss trial: sleeve vs bypass after 10 years

Meta-analysis: Barrett's after sleeve

What speaks against the claim?

Norwegian trial: bypass vs sleeve in type 2 diabetes

How often severe gullet inflammation follows sleeve

What does the overall evidence say?

Which position is better supported?

Why some studies weigh more

Remaining uncertainty

Justified conclusion

Open questions

How deeply was this checked?

In plain language

Studies on this claim

Studies supporting the claim (10)

Finnish trial: sleeve vs bypass after 10 years

Austrian follow-up 10+ years after sleeve

Endoscopy 5+ years after sleeve

Meta-analysis: Barrett's after sleeve

Swiss trial: sleeve vs bypass

Meta-analysis: reflux after sleeve

How often reflux disease develops after sleeve

International experts on reflux and sleeve

Swiss trial: sleeve vs bypass after 10 years

Danish study: acid medicines after sleeve vs bypass

Studies contradicting or limiting the claim (0)

Studies with mixed or unclear results (2)

How often severe gullet inflammation follows sleeve

Norwegian trial: bypass vs sleeve in type 2 diabetes

Regional context

Germany / EU

Egypt

What applies in my country?

General scientific assessment

References