What is that nighttime cough all about? In the last week, I’ve evaluated three patients with Lap-Bands who each have a history of severe GERD, nighttime cough, and pneumonia or chronic bronchitis. All three were seen by their primary care physician and then referred to a gastroenterologist for scopes. After a complete medical workup and months of taking medications such as Omeprazole, Carafate and Zantac with no resolution of their symptoms, they were sent back to me. Is it possible that the Lap-Band could have something to do with all of this?
Absolutely. This is a classic example of a Lap-Band that is too tight from either an overfill, a slip, or a prolapse of their band. These are all common side effects associated with the Lap-Band.
Denver’s Dry Air Might Not Be the Problem
When the band is too tight, food gets stuck above the band. It takes a long time to work through it or the patient vomits to get relief. The patient learns to eat “slippery” foods (shakes, smoothies, ice cream) that are more comfortable to eat. But, even still, food starts to hang up and back up into the esophagus. Over time, the esophagus starts to dilate and acts as an extension of the stomach. This allows the patient to eat more and a vicious cycle results. The symptoms associated with GERD are from the food, not from stomach acid as commonly believed. If food sits in the end of the esophagus, it is just as irritating to the esophagus as acid from the stomach. The Lap-Band prevents acid from the stomach to reflux, and likely why the medications don’t seem to work.
Next, the patient starts to wake up at night from a cough. It can become severe leading to chronic bronchitis or even pneumonia. If food is in the lower esophagus when the patient goes to bed and lies flat, the food and fluid can move up the esophagus. This leads to aspiration of food into the patient’s airway, causing the cough. The food or fluid can also lead to bronchitis and pneumonia. Many patients with this persistent problem learn to sleep in a chair to prevent the cough.
Robotic Lap Band Revision in Denver, CO
The bottom line is that if you have a Lap-Band and you develop symptoms of GERD or a nighttime cough, you should be evaluated by your bariatric surgeon. You simply may need an unfill of your Lap-Band which will resolve your reflux symptoms and cough immediately. You should also get an upper GI to help identify any problem. If your band was too tight and no other problem is detected, take some time off with the unfill, then restart the fills. If, however, the band has a slip or prolapse, then it may need to be removed. You can also choose to have the band removed and convert to another weight-loss operation such as a gastric sleeve or gastric bypass.
At the Colorado Bariatric Surgery Institute, we have expertise and experience in performing these procedures. We also do our bariatric procedures robotically, providing state-of-the-art technology which has definite benefits. Please give us a call (303-861-4505) if you have any of these symptoms as serious medical problems can occur if they are not treated properly.
Tom Brown, MD
Colorado Bariatric Surgery Institute