Question of the week: Severe Cough after Gastric Band Removal

Question of The Week: Gastric band removed. Have severe cough that has continued along with reflux, and shortness of breath. Who do I need to see about this? What type of doctor? Thank you.

Dear Leslie,

Lap Band weakens the anti-reflux barrier in so many different ways, especially when the band is over-filled resulting in excessive restriction. Lap Band over-restriction creates partial obstruction against normal esophageal contractions. This results in gastric pouch dilation, hiatal hernia formation and weak esophagus motility. All three conditions lead to severe acid reflux symptoms like heartburn, food regurgitation and cough. Cough results from gastric content reflux up to the throat level. Acid, bile and gastric enzymes irritate the vocal cords and laryngeal structures resulting in cough and hoarseness. If stomach content is drawn past the vocal cords and into the lungs, patients develop asthma related symptoms like wheezing, shortness of breath and dry chronic cough.

The best approach to your situation, Leslie, is to consult with an experienced acid reflux specialist. You need a comprehensive acid reflux workup that includes upper endoscopy, esophageal manometry and UGI contrast study. At Houston Heartburn and Reflux Center all three studies are done together under one roof and in less than one hour. Accurate information about your current anti-reflux barrier is crucial to tailor a treatment plan that best suits your particular condition.

Surgical options to reinforce the anti-reflux barrier include hiatal hernia repair with Nissen or Toupet fundoplication, sleeve gastrectomy or Roux-en-Y gastric bypass. Hiatal hernia repair restores the normal anatomy by reducing the stomach and lower esophageal sphincter into the abdominal cavity and away from the negative intra-thoracic pressure. Nissen fundoplication reliably restores the anti-reflux barrier and it effectively eliminates GERD related symptoms. Sleeve gastrectomy promotes gastric emptying and similar to gastric bypass, it diverts stomach acid away from the esophagus. Both gastric bypass and gastric sleeve surgery are effective weight loss procedures. Weight loss greatly contributes to acid reflux resolution. If you are overweight, a properly performed hiatal hernia surgery with concomitant sleeve gastrectomy or gastric bypass are indicated to control your acid reflux related symptoms.