Implications of a tight band – Reflux symptoms

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I hear from many patients that they are experiencing ‘reflux’ symptoms after gastric banding.

Although the symptoms can be similar to those experienced by reflux patients, namely food passing back into the oesophagus and/or a night cough, they seldom are.

Reflux occurs when the muscle between the stomach and the oesophagus relaxes when it shouldn’t, allowing stomach contents, including acid, to reflux up into the oesophagus. Although the symptoms are similar that’s not what is happening when the band patient experiences these symptoms.

Invariably these symptoms are caused by the band being too tight. As the band is so tight it’s regurgitation rather than acid reflux that the patient is experiencing. If untreated over a period of time this can cause motility in the oesophagus to weaken and make swallowing more difficult.

The issue is usually that the patient is not following the dietary guideline for success with a gastric band and has instead confused a tight band (with a high fill volume) with a functioning band. Diet is the key. When you are eating foods of the right texture slowly your band won’t need to be tight. Signs of a tight band are when you are vomiting even on small portions and when you can only satisfy calorie cravings with soft, sloppy foods that are high in fat or sugar.

When you notice this happening you need your band loosened, even if you are happy with your weight loss.

Aside from oesophageal motility problems, other problems arising from a tight band are a stretched pouch (often rendering the band useless) and an increased risk of band slippage. In fact, the gastric band is a good anti-reflux procedure when the right dietary guidelines are followed. This was demonstrated in a study by Dixon et al that showed a very high-resolution rate for patients experiencing reflux symptoms after gastric band surgery.

So, if you are experiencing reflux type symptoms with your band, get along to the clinic asap, prepare yourself for a de-fill and refocus on food textures and dietary behaviours.

Reference: Gastroesophageal Reflux in Obesity: The Effect of Lapband Placement – Dixon et al

Rishi Singhal

Rishi Singhal

Rishi is an expert bariatric surgeon based in the West Midlands and also Medical Director at Healthier Weight

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