Dilated esophagus and achalasia after lap band surgery

by Julie
(Washington State)

Dilated esophagus with retained column of barium and “bird’s beaking” suggestive of achalasia

Dilated esophagus with retained column of barium and “bird’s beaking” suggestive of achalasia

I was recently hospitalized for aspiration pneumonia. They thought it was related to the lap band, so they took it out. The GI doctor did and EGD and said I have a dilated esophagus and achalasia, and I am seeing him Monday to follow up.

I am wondering what to expect. Will this go away now that the band is out?

The docs said the band placement was fine and I had no fill for years. I believe the problem was not the result of a too tight band, rather a reaction to the band itself since the esophageal spasms started within the few months of band placement, before I had a fill. At the time I thought it was just normal and just the way it felt to have a band.

Comments for Dilated esophagus and achalasia after lap band surgery

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Feb 09, 2012
Achalsia
by: Lap Band Groupie

First, I'm not a Dr., but I'll tell you what I can (sorry this is long, and this first paragraph is more for others who just have aspiration pneumonia, reflux, or a dilated esophagus).

Generally Banders who develop aspiration pneumonia (this can be very serious, so I'm happy you're OK) due so due to two reasons; either they have a too tight Band and the food isn't passing fast enough so they aspirate food or more commonly reflux acid back up the esophagus. This generally happens at night while they're sleeping and they wake up coughing or choking. The food or acid caused the infection/pneumonia in the lungs. Secondly, even if your Band and Stoma are placed and working properly, Banders can overfill their pouch and over time stretch the esophagus and essentially use the lower portion of their esophagus as a second pouch to hold more food. Over time this can cause the bottom sphincter of their esophagus (purpose of it is to keep food and reflux from coming back up into your esophagus) to not close properly leaving your esophagus open to reflux acid and foods that can again be regurgitated into your lungs. If caught early on, these can usually be reversed with a complete unfill and after a few months things sometimes return to normal. Any signs of reflux, choking, or coughing during the night are red flags to get to your Doc.

Now on to you. I not very familiar with achalsia (rare disease of the esophagus, failure of the esophageal sphincter to relax/pass food), but I know that many LB Docs order an upper GI before Banding to rule out any esophageal/stomach problems like this, before surgery (I haven't hear of any Doc doing a LB procedure after achalsia is diagnosed). If the sphincter isn't releasing the food into the pouch then it will stay and can get aspirated into the lungs (probably again when you lay down), which sounds like what happened to you. Since you had no fill, a defill was ruled out and their only option was to remove the Band.

I've never heard of anyone saying this disease was 'caused' by the LB, but maybe your Doc was saying what other Banders have said that the symptoms of achalsia are exasperated by having the LB, when he said you were having 'a reaction to the LB'. It therefore sounds like you may have had this problem before Banding but didn't know it/were asymptomatic and I'm hopeful for your sake that since you didn't mention having issues before Banding that everything will return to normal and your achalsia will not be an issue. If not, it doesn't 'go away', but there are other treatments for the achalsia including oral medicines, balloon dilations, surgery, and even Botox to relax the muscle.

I'd also say that I'm surprised this wasn't caught earlier as you mentioned having esophageal spasms (can be very painful and isn't normal) early on and this wasn't diagnosed for years.

I'm sure your Doc will have more detailed answers and I hope you'll recover well. Let us know how you're doing. Best Wishes!

Jun 25, 2013
Bariatric surgeon at CBGSA , Arcadia , California
by: Dr. Troy LaMar

Hi Julie,
Not a whole lot to add to Lap Band Groupie's note. Would only add that in addition to the LES not working correctly in achalasia, the esophagus muscle does not work correctly either, ie. it does not move food down the esophagus correctly or at all.

Esophageal dilatation after lap banding is a known complication, and is not uncommon.

The question is does it become symptomatic. In your case it has, and removal of the band is warranted.

Often, the esophagus will rebound, or begin to function better with time... if not, the additional treatments will be available.

I'm glad you are following up with your surgeon.
Of note, our group rarely does bands anymore, and this is one of the reasons.

Good luck,

Dr. LaMar
(click here for Dr. LaMar's full bio & contact info)

los angeles bariatric surgeon

P.S. If you've found my recommendations or this web site helpful, please "Like" Bariatric Surgery Source by clicking the like button at the top of the left margin. Thank you!

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:
- Lap Band Problems & Lap Band Complications
- Lap Band Surgery Failure - 2 Types & How to Avoid Them

Image source: Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007, 2:38
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2040141

Nov 06, 2013
problems breathing
by: Anonymous

Did you find out? I have been having shortness of breath. My chest feels so heavy. I had my lapband removed and I still having breathing problems.

Jan 09, 2014
Lap Band follow ups
by: Kristie

Hi
I am a Lap Band patient of about seven years. The last five years I have had no follow up visits with my surgeon.

The reason is I had an office visit, were I received my last fill, and there was a lapse in my insurance that I wasn't aware about. This lack of insurance resulted in a 300.00 plus bill I have been unable to pay.

I'm currently on disability, with both Medicare and Medicaid. The doctor's office refuses care because of this unpaid bill even though Medicare covers my visits.

My question is: is this dangerous to go so long without any aftercare visits?

I recently have developed some acid reflux problems and am concerned about my esophagus.

Please advise. I receive $700 from social security. I think you can see why spending half my monthly income to pay one Bill has been a challenge.

So is it safe not to be seen after so many years? My understanding at the time of my surgery was that follow up care was a life long thing.

Thanks for any advise you can give. Kristie

Aug 05, 2014
I am in a similar position NEW
by: Janette

I too had to have my lapband removed due to reflux causing pneumonia but unfortunately for me I went septic in just a few short hours, no symptoms. It took 2 years and 2 additional pneumonia s before realizing it was the lapband.
They removed the lapband, repair an esophageal hernia and performed a gastric bypass.
I was doing great! everything seemed to have resolved and I was getting healthy again.
Then BOOM, 2 months ago i got really sick again.
2 weeks ago did a barium x-ray and it showed the reflux was back with a vengeance and that the LES was remaining open.
I am currently waiting auth for additional tests.
We havent discussed further options yet but the waiting is the hard part because it is possible to get seriously ill again.
Pray for me and I will pray for you!

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