Hello everyone and welcome to the question of the week, I'm doctor Alvarez from Endobariatric.com and on this episode we'll discuss the relationship with gastroesophageal reflux disease also know as GERD and the sleeve gastrectomy. First of all I want to start out by saying that a very high percentage of patients who are obese have reflux or GERD. Actually statistics say close to 50% of obese patients have GERD. Why? Well there may be several causes like an increase of intra-abdominal pressure, a hiatal hernia associated that's causing the reflux, low tone of the lower esophageal sphincter. Theres are the main causes. When we talk about increased abdominal pressure think of this as if you had ten bricks on your abdomen while you're laying down. This will cause pressure on your abdominal wall and increase the intraabdominal tension causing the heartburn or GERD. As patients lose the weight after surgery this pressure in our abdomen starts to lower and the GERD condition gets better. Now if we go into surgery and we do find a hiatal hernia that this occurs in about 15% of patients having weight loss surgery then we fix the hiatal hernia at the same time we do the sleeve to correct this anatomical condition. I have a video that I will place a link on the screen where I repair a hiatal hernia and do a sleeve at the same time. It will explain more on that condition. Now there is a strong association of reflux and the sleeve gastrectomy but I truly believe and it has been documented and studied that a good technique is fundamental on helping the reflux or eliminating it. It is also important to say that increased intraluminal pressure causes some reflux in some patients the first few weeks to months after the surgery. Some patients may need acid blockers during this time. Normally what we see is that patients that have heartburn or reflux before surgery are likely to continue with it. Some patients that had never had GERD may experience it after surgery and then we have the opposite where patients that have a history of GERD the condition gets better after surgery especially when a good surgical technique is applied. So that's it for the question of the week, don't forget to subscribe to our youtube channel that way you won't miss any gastric sleeve videos we upload. You can contact me via our social media that I personally manage or our contact information on our website www.endobariatric.com. To those of you who are my patients well you have my direct email. I'm Doctor Alvarez from endobariatric where we are changing lives one sleeve at a time. Take care.