We describe a patient who underwent horizontal gastroplasty for morbid obesity while exhibiting mild symptoms of gastroesophageal reflux disease. The patient lost 36.4 kg, but reflux symptoms progressed to the point of becoming almost incapacitating, associated with erosive esophagitis. The patient subsequently underwent vertical Roux-en-Y gastric bypass, becoming asymptomatic and demonstrating complete healing of the esophageal erosions. Post-operative esophageal pH monitoring demonstrated continuing pathologic reflux in this patient despite her being asymptomatic.