**4.5 GERD**

Significant GERD is considered a contraindication for LSG. Some studies show an increased prevalence of GERD in patients after LSG. This is likely due to hypotensive lower esophageal sphincter, disruption of the angle of His, reduced gastric compliance with higher intragastric pressure, and decreased gastric emptying. Late dilatation of the sleeve, and occurrence of hiatal hernia could also play a role in the worsening of GERD [81]. It is not recommended to empirically start antacid medication for prophylaxis after LSG [82]. However, for patients who develop reflux after LSG, treatment options are proton-pump inhibitors or conversion to RYGB [83].
