Morbid obesity and its associated diseases have become one of the serious public health issues that the whole world needs to face together, and bariatric and metabolic surgery remains the most effective long-term weight control method to date. Among all bariatric and metabolic procedures, sleeve gastrectomy (SG) is currently the most widely used, but it is not a perfect procedure. One of the most severe issues that this surgical procedure faces is the potential worsening of pre-existing or the development of de novo gastroesophageal reflux disease (GERD) after surgery. However, there is currently a lack of high-level clinical trial evidence regarding the diagnosis and treatment of GERD in patients undergoing SG. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts from China, Japan, and the Republic of Korea with extensive experience in bariatric and metabolic surgery and GERD treatment reached a consensus on the diagnosis and treatment of GERD in SG patients using the Delphi method. This consensus includes a total of 59 consultation questions, with agreement reached on 44 of them. It is hoped that this consensus will not only serve as a reference for clinical diagnosis and treatment but also provide more potential directions for future high-quality clinical research.