Some sense of restriction is how a Lap-Band works, but food that regularly sticks, comes back up, or will not go down is not normal. The usual causes are a band that is too tight, food not chewed well enough, a stretched pouch above the band, a slipped band, or a widened esophagus. Most are treated by removing some fluid; a few need the band taken out.
What normal restriction feels like, and what does not
With a well-adjusted band you should be able to swallow water and medicines easily, eat small amounts of solid food slowly, and feel satisfied for a few hours. Occasional sticking after a large or poorly chewed bite can happen. Our page on Lap-Band adjustments and tightness describes the normal range in detail.
Dysphagia, the medical word for trouble swallowing, is different. Signs include food or liquid "stacking up" in the chest, bringing back food or foamy saliva (regurgitation), needing to live on soft foods and liquids, and pain or pressure behind the breastbone when you eat. In the original U.S. trial summarised by the FDA, dysphagia was reported in 9% of the 299 people enrolled and was most often linked to band slippage, stoma obstruction (a blocked band opening), or nausea and vomiting.
Common causes
A band that is too tight, or a blocked opening
If too much fluid is in the band, the opening below the pouch becomes too small. The FDA labeling cautions against adding so much saline that the opening closes, and says the adjustment should be checked by having the patient drink water. Stoma obstruction was reported in 14% of people in the FDA trial; signs included vomiting, upper-abdominal pain, reflux and dehydration.
Food not chewed well enough
The FDA labeling says patients "must be cautioned to chew their food thoroughly," and that people with dentures should cut food into small pieces. It warns that failing to do so may cause vomiting, swelling at the opening and even obstruction. Our eating after Lap-Band surgery page has practical tips.
A stretched pouch or slipped band
The pouch above the band can enlarge evenly (pouch dilation) or the stomach can slip up through the band. The Canadian Journal of Surgery review by Eid and colleagues describes pouch enlargement as "a pressure-related phenomenon" that may be caused by an over-filled band or overeating. Both can cause food to sit above the band and come back up. See Lap-Band slippage.
A widened esophagus
When food meets resistance at the band again and again, the esophagus above it can stretch. This is called esophageal dilation. A study in Surgical Endoscopy (Milone and colleagues, 2008) found esophageal dilation on barium X-ray in 14% of patients checked one year after banding. Those patients had more reflux symptoms and vomiting. A severe, late form is sometimes called megaesophagus. A Cleveland Clinic Florida series (Arias and colleagues, 2009) found it in 1.9% of 257 patients, on average 32 months after surgery.
What is done about it
Loosening the band
Removing fluid is the first step for most swallowing problems. The FDA labeling states that "deflation of the band is recommended if esophageal dilatation develops." In the FDA trial, most episodes of esophageal dilation appeared to resolve with deflation, although the FDA notes that "the long term consequences of this event are not known." For pouch dilation, the Eid review reports that removing fluid and changing eating habits worked in up to 77% of patients.
When loosening is not enough
The Eid review considers conservative treatment unsuccessful if the pouch has not returned to its original size after 8 to 10 weeks, and then band removal or replacement is considered. In the Arias series, all patients with megaesophagus improved partly after deflation but needed band removal because symptoms continued. The FDA labeling also notes that some types of esophageal dysmotility (abnormal movement of the esophagus) can lead to dilation when the band is inflated and may require removal. The Lap-Band revision page explains the options after removal.
Food stuck that will not pass
Kodner and Hartman, in an American Family Physician review, describe treating a blocked opening by deflating the band or removing the stuck food with an endoscope (a thin camera tube passed through the mouth). If that does not correct it, the band may need to come out.
When to call
Go to an emergency room or call 911 if
- You cannot swallow water or your own saliva
- You have severe chest or abdominal pain
- You are vomiting blood or have black stools
- You feel dizzy, very weak or are passing very little urine after repeated vomiting
Call the office if
- Food sticks or comes back up most days
- You have switched to soft foods or liquids because solids will not go down
- You bring up foamy saliva, especially at night
- Swallowing problems began after a fill
Frequently asked questions
What should I do if a bite of food is stuck right now?
Stop eating and do not try to wash it down with more food or large gulps of liquid. Stand or sit upright and wait. Often the food passes or comes back up. If you then cannot swallow even small sips of water or saliva, go to an emergency room. If it passes but happens again and again, call the office.
Can my esophagus go back to normal after the band is loosened?
Often it improves. The FDA trial found that most esophageal dilation appeared to resolve with deflation, but the long-term consequences are not known. In the Arias series, severe cases improved only partly and needed band removal. A repeat barium X-ray after loosening shows whether the esophagus has narrowed again.
Why do bread, rice and dry meat stick more than other foods?
Doughy bread, pasta and rice can turn gummy and form a lump, and meat that is not chewed fine enough can lodge at the band. Our eating page suggests toasting bread, cutting meat small and chewing well. If many foods stick, the band may be too tight or the anatomy may have changed, and that should be checked.
Is bringing up foam or saliva a sign something is wrong?
Occasionally bringing up foamy saliva after eating too fast can happen. Doing it most days, or waking at night with it, suggests that saliva is pooling above an opening that is too narrow, or above a stretched pouch or esophagus. That is a reason to call and have the band checked.
Talk with Dr. Davtyan in Rancho Cucamonga
Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon who also lives with a Lap-Band. The Rancho Cucamonga office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730; call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use the contact page. The first consultation is complimentary, Hablamos Español, and the Rancho Cucamonga Lap-Band guide links to related pages.
Sources
More in the Lap-Band in Rancho Cucamonga guide
Start at the Lap-Band in Rancho Cucamonga page, or go straight to a topic.
Understanding your band
Weighing your options
Getting care in Rancho Cucamonga
