Heartburn and Acid Reflux With a Lap-Band: Causes and What Helps

Heartburn and Acid Reflux With a Lap-Band: Causes and What Helps

Reflux with a Lap-Band is common and has more than one cause. A band that is too tight, a stretched pouch above the band, a slipped band or a widened esophagus can all push food and acid back up. Some people have ordinary reflux unrelated to the band. Treatment starts with finding the cause, and may involve eating habits, acid-reducing medicine, removing fluid, or in some cases removing the band.

Reflux and the band: what the research shows

Gastroesophageal reflux disease (GERD) means stomach contents flow back into the esophagus, the tube from your throat to your stomach, causing heartburn, sour taste or cough. The band's effect on reflux has been debated for years.

A systematic review in Obesity Reviews (de Jong and colleagues, 2010) pooled 20 studies and 3,307 patients. In the short term, the share of people with reflux symptoms fell from about 33% before surgery to about 8% after. But the authors also found that "worsening or newly developed reflux symptoms and esophagitis are found in a subset of patients during longer follow-up." New reflux symptoms appeared in about 15% of patients. The share of people with abnormal esophageal movement (dysmotility) rose after banding.

In the original U.S. trial summarised by the FDA, gastroesophageal reflux was reported by 34% of the 299 people enrolled at some point over three years. An American Family Physician review (Kodner and Hartman, 2014) states that new or worsening GERD symptoms "may occur in up to one-third of patients."

Why reflux can start or get worse with a band

The band is too tight

When the opening below the pouch is too narrow, food and saliva sit above the band. Lying down lets them come back up. This is a common cause of night-time heartburn, coughing or waking up choking. Our page on Lap-Band adjustments and tightness describes the other signs of an over-tight band.

The pouch has stretched or the band has slipped

The Eid review in the Canadian Journal of Surgery lists heartburn, regurgitation and occasional chest pain among the symptoms of pouch enlargement. The FDA summary lists reflux as one of the symptoms reported with band slippage. A larger pouch holds more food and acid above the band. See Lap-Band slippage.

The esophagus has widened

Over time, pushing food through a tight band can stretch the esophagus. A study in Surgical Endoscopy (Milone and colleagues, 2008) found that people with a dilated esophagus a year after banding had more reflux symptoms and vomiting than those without. See trouble swallowing with a Lap-Band.

Ordinary reflux

Reflux is common in general, and some band patients have reflux for the usual reasons, such as a hiatal hernia (part of the stomach pushing up through the diaphragm). Kodner and Hartman note that repairing a hiatal hernia at the time of banding reduces later reoperation.

What helps

Kodner and Hartman list the usual treatment steps for persistent reflux with a band: changes in eating habits, a proton pump inhibitor (an acid-reducing medicine), removing fluid from the band, and, if these do not work, removing the band. They state that eating changes and acid-suppressing medicine "usually control symptoms."

Give the pouch time to empty before you lie down. Food still sitting above the band at bedtime is more likely to come back up.
Eat small portions slowly and stop at the first sign of fullness. Overfilling the pouch raises the pressure above the band.
Raise your head during sleep. NIDDK suggests raising the head 6 to 8 inches for reflux.
Ask about medicine. Your doctor may suggest an acid-reducing medicine and can discuss its benefits and risks.
Have the band checked. If reflux started after a fill, a small fluid removal may help. If reflux started without a fill change, imaging is usually needed before any adjustment.

If reflux keeps coming back even with a looser band, the conversation may move to removing the band or converting to another operation. Our Lap-Band revision page explains how surgeons choose between removal, a sleeve or a bypass.

How reflux with a band is checked

Kodner and Hartman name upper endoscopy and a pH probe (a test that measures acid in the esophagus over a day or so) as ways to diagnose GERD with a band. An upper GI X-ray shows whether the band has slipped, the pouch has grown or the esophagus is wider than normal. Our tests for Lap-Band problems page describes each one.

When to call

Go to an emergency room or call 911 if

You have chest pain, especially with shortness of breath, sweating or pain spreading to the arm or jaw. Heart problems can feel like heartburn.
You vomit blood or material that looks like coffee grounds, or pass black stools
You cannot keep liquids down

Call the office if

Heartburn or night-time cough is new, or worse than it was
You wake up choking or with food or acid in your mouth
You are taking acid medicine most days and still have symptoms

Frequently asked questions

Why is my reflux worse at night since I got my band?

When you lie flat, anything sitting above the band can flow back into the esophagus. If the band is tight or the pouch has enlarged, more food and saliva collect there. A light, early evening meal helps, but night symptoms that keep happening are worth reporting, because they can be a sign the band needs to be checked.

Does reflux always mean my band is too tight?

No. A tight band is one cause, but a stretched pouch, a slipped band, a widened esophagus or ordinary reflux can feel the same. That is why reflux that starts without a recent fill should be investigated, not just treated by removing fluid. The right fix depends on which cause is present.

Will taking the band out stop my reflux?

It may help when the band is the cause, but no one can promise that. If the esophagus has stretched or its movement has changed, it may not fully recover; the FDA summary notes that the long-term consequences of esophageal dilation are not known. Ordinary reflux can also remain. Your surgeon will discuss what the tests show before any decision.

Is a chronic cough at night related to my band?

It can be. Acid or food coming back up while you sleep can reach the throat and cause coughing, hoarseness or a sore throat in the morning. Kodner and Hartman list chronic cough among the symptoms of reflux after banding. A cough can also have other causes, so mention it to your surgeon and your regular doctor.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon and has a Lap-Band himself. You can reach the Rancho Cucamonga office at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730, by calling 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or through the contact page. The first consultation is complimentary, Hablamos Español, and more answers are in the Rancho Cucamonga Lap-Band guide.

Heartburn and Acid Reflux With a Lap-Band: Causes and What Helps