Pain in the chest when swallowing after gastric sleeve surgery can be a concerning symptom. This sensation, often described as discomfort or pressure, arises as the body adapts to significant anatomical changes. Understanding the potential reasons, from expected healing processes to more serious complications, is important for post-operative recovery.
Expected Sensations and Common Causes
Immediately following gastric sleeve surgery, patients may experience a range of sensations in the chest and upper abdomen, part of the normal healing process. Mild to moderate discomfort or pain, particularly around incision sites, is common. A feeling of pressure or soreness in the lower chest or upper abdomen can relate to the body adjusting to the altered stomach size. This discomfort often subsides as initial post-operative swelling resolves.
Temporary issues specific to swallowing can arise from the body’s adaptation to the new, narrower stomach. Rapid eating or drinking, or insufficient chewing, can lead to food feeling “stuck” in the esophagus, causing chest discomfort. Eating foods that are too dry or dense can also contribute to this feeling.
Mild acid reflux (GERD) is another frequent cause of chest pain after surgery, where stomach acid flows back into the esophagus, leading to a burning sensation. Esophageal spasms, characterized by uncoordinated muscle contractions, may also cause pain or a squeezing feeling in the chest when swallowing. These common causes are typically manageable with dietary adjustments and medication.
Signs of Serious Complications
Certain symptoms can indicate a more serious underlying complication requiring immediate medical attention. One concern is a staple line leak, a hole along the newly stapled stomach allowing gastric contents to leak into the abdominal cavity. Symptoms of a leak include severe or worsening abdominal pain, chest pain, rapid heart rate, fever, chills, and respiratory distress. This complication, though rare (occurring in about 1-3% of cases), can be life-threatening if not addressed promptly.
Another serious issue is a stricture, which is a narrowing of the stomach tube or the connection between the stomach and esophagus. Symptoms include persistent difficulty swallowing, nausea, vomiting, a feeling of fullness after eating small amounts, and trouble tolerating certain foods. Strictures can develop weeks to months after surgery, typically within the first three months, and may be caused by scar tissue formation or the surgical technique. Ulcers, sores in the lining of the stomach, can also cause severe burning pain in the upper middle abdomen, sometimes accompanied by nausea, vomiting, or blood in stool or vomit. Factors like NSAID use, smoking, or a bacterial infection (Helicobacter pylori) can contribute to ulcer development.
Less common but still possible complications include hernias and perforations. While often presenting as abdominal pain, some types, like hiatal hernias, can contribute to difficulty swallowing and chest pain. A perforation, a hole in the gastrointestinal tract, can lead to severe abdominal pain, fever, nausea, and vomiting, and requires urgent intervention. Any sudden, sharp, or worsening chest pain, especially when accompanied by fever or signs of infection, warrants immediate medical evaluation.
Managing Discomfort and Seeking Medical Guidance
For mild discomfort after gastric sleeve surgery, several self-management strategies can help alleviate symptoms related to swallowing. Eating slowly and chewing food thoroughly into a very fine consistency is important to prevent food from getting stuck and to aid digestion. Consuming smaller, more frequent meals can also reduce pressure on the new stomach pouch.
Staying well-hydrated by sipping liquids between meals, rather than with meals, helps prevent food blockages and supports overall recovery. Avoiding trigger foods, such as tough meats, dry bread, spicy foods, or highly acidic items, can also minimize discomfort and acid reflux. Following the dietary guidelines provided by the surgical team and taking any prescribed medications, such as acid reducers, as directed is important.
Seek prompt medical attention if chest pain when swallowing is severe, persistent, or accompanied by other concerning symptoms. Contact your medical team immediately if you experience:
Severe or worsening pain not relieved by medication
Fever of 101.5°F (38.6°C) or higher
Chills
Persistent nausea or vomiting lasting more than 12 hours
Shortness of breath
Rapid heart rate
Pain radiating to the left shoulder
During a medical evaluation, healthcare providers may perform diagnostic tests. These could include an upper gastrointestinal (GI) series with contrast to visualize the digestive tract, an upper endoscopy to examine the esophagus and stomach, or a CT scan if a leak is suspected. Treatment approaches vary based on the diagnosis, ranging from medication adjustments to endoscopic procedures like balloon dilation for strictures, or surgical intervention.