Gastroesophageal reflux disease (GERD) and sleeve gastrectomy (SG) have a complex relationship, with outcomes ranging from symptom resolution to the development of de novo GERD. The impact of SG on GERD is influenced by factors such as amelioration of obesity, disruption of the angle of His, increased intragastric pressure, and intrathoracic sleeve migration. However, the variability in reported outcomes underscores the need for improved patient selection, robust preoperative evaluation, and long-term research to refine management strategies. A multidisciplinary approach integrating medical, endoscopic, and surgical expertise is essential to optimize outcomes for SG patients with GERD.