Post band Acid reflux
This is info I found on a blog. It is by the same nurse the rest of the info I have been sharing-
We should never just cover up symptoms of reflux with medications. We
must find and
correct the REASON for it. Relux before banding is very different
than reflux after banding - different causes, different treatment,
and different problems from it. It is especially dangerous for
bandsters and must NEVER be tolerated.
Reflux - why we must avoid it
What is Reflux?
Reflux (GERD or Gasto-Esophageal Reflux Disease) is caustic stomach
acid that comes back up into the esophagus, where it does not belong.
The stomach has a protective lining that prevents this stomach acid
from causing stomach damage, but no other tissue in the body has this
protection. Any acid that contacts areas other than the stomach
tissues easily causes damage.
Reflux causes ear infections, sinus infections, throat infections,
new or worsening asthma, tooth decay, and if we inhale it at night
when we wake up coughing and choking, it can cause a very bad
aspiration pneumonia. Untreated reflux can also cause esophageal
cancer, which is on the rise in the US.
What causes Reflux (GERD) before banding?
Many obese people have a hiatal hernia which causes reflux before
banding. Most also have a damaged valve at the top of the stomach,
called the LES (Lower Esophageal Sphincter) that is damaged from
abdominal fat back-pressure. The valve does not close correctly,
allowing stomach acid to back up into the esophagus. Many need
surgery to repair the hernia, and/or acid-reducers to try to minimize
the damage. Being very obese and having a hiatal hernia and it's
associated health problems is one of the several conditions that is
considered a "Co-morbidity" and a reason to get Band surgery.(NOT a
reason it cannot be done)
With Band surgery, most of these hiatal hernias need to be
repaired, since the hiatal hernia is just where the band must go.
They are so routinely repared that the Band surgeons sometimes don't
even tell us we had a hernia, but I believe we should know. It can
make recovery bit more painful and lengthy. With known reflux before
sugery, some band surgeons want a pre-op upper GI to evaluate the
size of the hernia so they can better plan surgery.
Of those who had a hiatal hernia causing reflux before band surgery,
about 76% are completely cured with Band Surgery. Another 14% see a
huge improvement. A few see only moderate relief.
What about reflux (GERD) AFTER banding?
Reflux starting AFTER band surgery is another thing entirely, and
with very different causes. Bandster reflux must be avoided., as it
is harmful in a number of ways.
When reflux starts after a new fill, it almost always means the fill
is TOO TIGHT and needs some fill removed. If we get back in very
quicky before swelling and damage occurs, as little as 0.2 cc or so
out will relieve the reflux. It is not enough to simply cover up
reflux symptoms with medication - the CAUSE of the reflux must be
found and fixed.
When new reflux starts that is NOT associated with a new fill, it is
a sign of possible problems that must be checked out if it persists.
First, though, be sure you're following the "Anti-reflux Guidelines
for Bandsters", below. If new reflux persists despite these
measures, we must consider a Band slip or pouch dilation as the
cause and see our docs quickly for a fluoro and treatment.
ANY Bandster with a new ear infecton, sinus infection, new or
worsening asthma, or pneumonia must consider reflux as the cause and
discuss this possibility with family and band docs. Family docs
often don't know about this connection. We must help them learn.
What are symptoms of reflux?
1. Chest burning or pain
2. Acid laryngitis. This is condition that includes hoarseness, dry
cough, the sensation of having a lump in the throat, and the need to
repeatedly clear the throat.
3. Trouble swallowing (dysphagia). In severe cases, patients may even
choke or food may become trapped in the esophagus, causing severe
chest pain. This may indicate a temporary spasm that narrows the
tube, or it could also be an indication of serious esophageal damage
or abnormalities.
4.Chronic sore throat.
5.Persistent hiccups or burping .
6. Coughing and Respiratory Symptoms. Asthmatic symptoms like
coughing and wheezing may occur. In fact, in one study, GERD alone
accounted for 41.1% of cases of chronic cough in nonsmoking patients.
The incidence was even higher when GERD and asthma were combined.
ANY new or worseing asthma in a Bandster should be very suspicious of
reflux.
7. Chronic Nausea and Vomiting. Nausea that persists for weeks or
even months and is not attributable to a common cause of stomach
upset may be a symptom of acid reflux. In rare cases, vomiting can
occur as often as once a day. All other causes of chronic nausea and
vomiting should be ruled out, including ulcers, stomach cancer,
obstruction, and pancreas or gallbladder disorders.
8. Acid or metallic taste in the mouth
9. Chronic or persistent ear or sunus infections
How can Bandsters prevent Reflux?
There are several standard things Bandsters should always do to
prevent reflux. Since some reflux cannot be felt and the damage is
still occurring, these preventative things should be very routine for
Bandsters. As we get tighter and tighter with fills, the guidelines
will become even more important to heed.
1. never keep a too-tight fill, thinking it will get better in time.
A too-tight fill is the #1 reason for ALL the serious band problems,
including reflux. There is just NEVER any good that results from too-
tight fill.
2. Don't eat solids within 2 hrs of bedtime. Anything in the pouch
or stomach when we lay flat encourages reflux. Some people may not be
able to eat solids within 3 hrs of bedtime.
3. If you nap during the day, use a recliner with your head higher
than your belly. The gravity helps keep stomach acid where it
belongs.
4. Take no meds within an hour of bedtime. Take them one hour before
laying flat, with a full glass of water to wash them completely
through the pouch.
5. ONE hour before bedtime, have a full glass of water (only).,
whether you take "bedtime" meds or not. This rinses out the pouch
and dilutes the night's stomach acid.
6. Stay very well hydrated, so the normal stomach acid is not
concentrated. For Bandsters, this means at least 80-100 oz a day of
no-calorie fluids. Adequate fluids are essential for Bandsters for
many other reasons too, including good weight loss, normal stools,
less variation in restriction, and much more.
7. Some foods/fluids encourage reflux. If you have any reflux,
minimize or avoid them:
Coffee, caffeine, alcohol, chocolate, citrus (including tomatoes,
kiwi, strawberries, pineapple) , mint, greasy/spicy foods, onions,
garlic, all carbonation. A cup or two of normal-strength coffee in
the morning is ok for most people, especially if buffered with milk
or creamer, IF there is no burning or reflux.
8. Avoid clothes that are tight around the waist, as this increases
the stomach back-pressure that encourages reflux.
9.. Those with severe reflux who cannot get in at once for an unfill
should raise the head of their bed 6 inches on blocks or books, or
sleep in a recliner, until they see their docs. This will help
prevent the asoiraton oneumonia comon if acid is inhaled into the
lungs at night. Just adding extra pillows is NOT enough; the head of
the flat bed must be raised.
10. Avoid NSAID use for more than 2-3 days maximum. NSAIDs are known
to alter the protective lining of the stomach after about 3 days,
and then stomach acid can damage the stomach. THis alteration of the
potective lining CANNOT be prevented by simply washing the NSAID
thru the pouch, and is the major damage NSAIDs cause in Bandsters.
Some surgeons feel this is one of the causes of band erosions.
11. Some other medications also increase the risk of reflux. Look up
all meds you are asked to take, and request ones wih the least risk
of reflux and stomach irritation. A good place to look up medications
is www.drugs.com . Take all meds correctly, as per special Bandster
needs.
Acid-reducing Drugs
Some with persistent reflux despite all preventative measures must
take regular acid-reducers like nexium, prilosec, or protonix.
However, These are not without side effects, so should not be taken
routinely, unless really needed. Side-effects include nausea,
constipation,an diarrhea.
Many acid-reducers also interfere with medication and nutrient
absorption, and used longterm, can cause nerve damage and B-12
deficiencies. Some wih kidney disease sould not take these meds (and
many with diabetes have some degree of kidney disease even though
routine tests may not show it)
Others on low-salt diers should also not take some acid-reducers.
As with ALL Bandster problems, PREVENTION of problems
is the key. It's much easier to prevent problems by following good
bandster habits, than to try to pick up the pieces after we are
already having trouble. With a good understanding of reflux and it's
causes in bandsters, it is easy to prevent it and all the many
problems it
causes.
c. Sandy Richards, BSN, MN
Band Educator
at goal> 5 yrs
We should never just cover up symptoms of reflux with medications. We
must find and
correct the REASON for it. Relux before banding is very different
than reflux after banding - different causes, different treatment,
and different problems from it. It is especially dangerous for
bandsters and must NEVER be tolerated.
Reflux - why we must avoid it
What is Reflux?
Reflux (GERD or Gasto-Esophageal Reflux Disease) is caustic stomach
acid that comes back up into the esophagus, where it does not belong.
The stomach has a protective lining that prevents this stomach acid
from causing stomach damage, but no other tissue in the body has this
protection. Any acid that contacts areas other than the stomach
tissues easily causes damage.
Reflux causes ear infections, sinus infections, throat infections,
new or worsening asthma, tooth decay, and if we inhale it at night
when we wake up coughing and choking, it can cause a very bad
aspiration pneumonia. Untreated reflux can also cause esophageal
cancer, which is on the rise in the US.
What causes Reflux (GERD) before banding?
Many obese people have a hiatal hernia which causes reflux before
banding. Most also have a damaged valve at the top of the stomach,
called the LES (Lower Esophageal Sphincter) that is damaged from
abdominal fat back-pressure. The valve does not close correctly,
allowing stomach acid to back up into the esophagus. Many need
surgery to repair the hernia, and/or acid-reducers to try to minimize
the damage. Being very obese and having a hiatal hernia and it's
associated health problems is one of the several conditions that is
considered a "Co-morbidity" and a reason to get Band surgery.(NOT a
reason it cannot be done)
With Band surgery, most of these hiatal hernias need to be
repaired, since the hiatal hernia is just where the band must go.
They are so routinely repared that the Band surgeons sometimes don't
even tell us we had a hernia, but I believe we should know. It can
make recovery bit more painful and lengthy. With known reflux before
sugery, some band surgeons want a pre-op upper GI to evaluate the
size of the hernia so they can better plan surgery.
Of those who had a hiatal hernia causing reflux before band surgery,
about 76% are completely cured with Band Surgery. Another 14% see a
huge improvement. A few see only moderate relief.
What about reflux (GERD) AFTER banding?
Reflux starting AFTER band surgery is another thing entirely, and
with very different causes. Bandster reflux must be avoided., as it
is harmful in a number of ways.
When reflux starts after a new fill, it almost always means the fill
is TOO TIGHT and needs some fill removed. If we get back in very
quicky before swelling and damage occurs, as little as 0.2 cc or so
out will relieve the reflux. It is not enough to simply cover up
reflux symptoms with medication - the CAUSE of the reflux must be
found and fixed.
When new reflux starts that is NOT associated with a new fill, it is
a sign of possible problems that must be checked out if it persists.
First, though, be sure you're following the "Anti-reflux Guidelines
for Bandsters", below. If new reflux persists despite these
measures, we must consider a Band slip or pouch dilation as the
cause and see our docs quickly for a fluoro and treatment.
ANY Bandster with a new ear infecton, sinus infection, new or
worsening asthma, or pneumonia must consider reflux as the cause and
discuss this possibility with family and band docs. Family docs
often don't know about this connection. We must help them learn.
What are symptoms of reflux?
1. Chest burning or pain
2. Acid laryngitis. This is condition that includes hoarseness, dry
cough, the sensation of having a lump in the throat, and the need to
repeatedly clear the throat.
3. Trouble swallowing (dysphagia). In severe cases, patients may even
choke or food may become trapped in the esophagus, causing severe
chest pain. This may indicate a temporary spasm that narrows the
tube, or it could also be an indication of serious esophageal damage
or abnormalities.
4.Chronic sore throat.
5.Persistent hiccups or burping .
6. Coughing and Respiratory Symptoms. Asthmatic symptoms like
coughing and wheezing may occur. In fact, in one study, GERD alone
accounted for 41.1% of cases of chronic cough in nonsmoking patients.
The incidence was even higher when GERD and asthma were combined.
ANY new or worseing asthma in a Bandster should be very suspicious of
reflux.
7. Chronic Nausea and Vomiting. Nausea that persists for weeks or
even months and is not attributable to a common cause of stomach
upset may be a symptom of acid reflux. In rare cases, vomiting can
occur as often as once a day. All other causes of chronic nausea and
vomiting should be ruled out, including ulcers, stomach cancer,
obstruction, and pancreas or gallbladder disorders.
8. Acid or metallic taste in the mouth
9. Chronic or persistent ear or sunus infections
How can Bandsters prevent Reflux?
There are several standard things Bandsters should always do to
prevent reflux. Since some reflux cannot be felt and the damage is
still occurring, these preventative things should be very routine for
Bandsters. As we get tighter and tighter with fills, the guidelines
will become even more important to heed.
1. never keep a too-tight fill, thinking it will get better in time.
A too-tight fill is the #1 reason for ALL the serious band problems,
including reflux. There is just NEVER any good that results from too-
tight fill.
2. Don't eat solids within 2 hrs of bedtime. Anything in the pouch
or stomach when we lay flat encourages reflux. Some people may not be
able to eat solids within 3 hrs of bedtime.
3. If you nap during the day, use a recliner with your head higher
than your belly. The gravity helps keep stomach acid where it
belongs.
4. Take no meds within an hour of bedtime. Take them one hour before
laying flat, with a full glass of water to wash them completely
through the pouch.
5. ONE hour before bedtime, have a full glass of water (only).,
whether you take "bedtime" meds or not. This rinses out the pouch
and dilutes the night's stomach acid.
6. Stay very well hydrated, so the normal stomach acid is not
concentrated. For Bandsters, this means at least 80-100 oz a day of
no-calorie fluids. Adequate fluids are essential for Bandsters for
many other reasons too, including good weight loss, normal stools,
less variation in restriction, and much more.
7. Some foods/fluids encourage reflux. If you have any reflux,
minimize or avoid them:
Coffee, caffeine, alcohol, chocolate, citrus (including tomatoes,
kiwi, strawberries, pineapple) , mint, greasy/spicy foods, onions,
garlic, all carbonation. A cup or two of normal-strength coffee in
the morning is ok for most people, especially if buffered with milk
or creamer, IF there is no burning or reflux.
8. Avoid clothes that are tight around the waist, as this increases
the stomach back-pressure that encourages reflux.
9.. Those with severe reflux who cannot get in at once for an unfill
should raise the head of their bed 6 inches on blocks or books, or
sleep in a recliner, until they see their docs. This will help
prevent the asoiraton oneumonia comon if acid is inhaled into the
lungs at night. Just adding extra pillows is NOT enough; the head of
the flat bed must be raised.
10. Avoid NSAID use for more than 2-3 days maximum. NSAIDs are known
to alter the protective lining of the stomach after about 3 days,
and then stomach acid can damage the stomach. THis alteration of the
potective lining CANNOT be prevented by simply washing the NSAID
thru the pouch, and is the major damage NSAIDs cause in Bandsters.
Some surgeons feel this is one of the causes of band erosions.
11. Some other medications also increase the risk of reflux. Look up
all meds you are asked to take, and request ones wih the least risk
of reflux and stomach irritation. A good place to look up medications
is www.drugs.com . Take all meds correctly, as per special Bandster
needs.
Acid-reducing Drugs
Some with persistent reflux despite all preventative measures must
take regular acid-reducers like nexium, prilosec, or protonix.
However, These are not without side effects, so should not be taken
routinely, unless really needed. Side-effects include nausea,
constipation,an diarrhea.
Many acid-reducers also interfere with medication and nutrient
absorption, and used longterm, can cause nerve damage and B-12
deficiencies. Some wih kidney disease sould not take these meds (and
many with diabetes have some degree of kidney disease even though
routine tests may not show it)
Others on low-salt diers should also not take some acid-reducers.
As with ALL Bandster problems, PREVENTION of problems
is the key. It's much easier to prevent problems by following good
bandster habits, than to try to pick up the pieces after we are
already having trouble. With a good understanding of reflux and it's
causes in bandsters, it is easy to prevent it and all the many
problems it
causes.
c. Sandy Richards, BSN, MN
Band Educator
at goal> 5 yrs
. 
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