How Could AGB Cause Achalasia?

I've been trying to figure this out, since my Dx was confirmed last week.  I kept my band loose, 3.5 cc in 11 cc Realize C band.  I ate per my doctor's and nutritionist's directions.  I didn't drink with meals, though drinking with meals might be better.  I cut my food into 1/4 inch pieces, chewed 15-25 times. In fact, I was doing all this for 3 months prior to surgery.  I ate 1/2 to 1 cup food, taking 20-30 min to finish.  I stopped eating with the "soft stop" signs.  So what's the problem?

The problem is that our pouch can only hold 1-2 oz of food.  A half cup is 4 oz.  If you're a little bit too tight, food will be retained in the pouch, putting back pressure on the gastroesophageal junction.  Eating a cup of food a year or more out, isn't  unusual and this would be 4-8 times the capacity of the pouch. As we're told not to drink at all with our meals, the food stays in the pouch, longer, which can be a problem. Any random tightening, a fickle band, can have disastrous consequences to the esophageal function.  An ounce is appx 29 cc, my manometry test involved just 45 cc of saline (about 1.5 oz).  It doesnt take much to cause problems.  The esophagus is not intended to hold food at all.  Continued episodes of this causes nerve damage and will present initially as heartburn or GERD symptoms.  This is misleading and potentially damaging.  How many times have you seen a post where someone states their heartburn had returned and their doctor puts them back on a PPI?  What is needed is an Esophogram to determine if they've become too tight (if its been some time since their last fill) or a small unfill if they've had a recent fill.  If there is any chest or epigastric pain, further tests would be in order to rule out esophageal problems.  Manometry can pick up small changes indicating damage that cannot be seen with EGD or UGI, avoiding further damage by unfilling the band or removing it all together.

This sort of explains why the "rules" around eating and drinking with a band should be changed and might result in fewer complications and that quicker pouch emptying might be a good thing.  I've been drinking with meals again for a few months, but have noticed no difference in satiety.   

Let me emphasize something here.  This post is intended to educate and share knowledge in order to spare someone else the problems so many of us have had.  Most of the time achalasia secondary to AGB is reversible with emptying or removing the band, but it is a contraindication to VSG, eliminating that surgery as an option for revision.  Getting a band might prevent a person from being able to revise to their surgery of choice, eliminating all but malabsorptive options (RNY and DS).  

http://www.ajronline.org/doi/full/10.2214/AJR.04.0655

http://link.springer.com/article/10.1381%2F09608920677522200 5?LI=true

http://www.ncbi.nlm.nih.gov/pubmed/22411570

http://www.searchmedica.com/xml-resource.html?c=pc&ss=defLin k&p=Funnelback&rid=http%3A%2F%2Fubm-search01.squiz.co.uk%2Fs earch%2Fcache.cgi%3Fcollection%3Dpubmed%26doc%3D61%252F21683 804.xml%26off%3D0%26len%3D-1%26url%3Dhttp%253A%252F%252Fubm- search01.squiz.co.uk%252Fpublic%252Fpubmed%252F21683804.xml& t=pubmed

THANKS for extremely informative  information Steph!!

Oh wow......I do think my surgeon is correct.  He doesn't think that the band will be around in 10 years.  I am thankful that my esophagus seems to be working okay, now, and I was able to revise to the sleeve. 

I agree..it's either on the way out or there's going to be some major rethinking of design and/or postoperative protocol.

My esophagus was damaged from the band, I revised to a sleeve.  I can tell it isn't working right so have to work with it.

Thank you for the VERY INFORMATIVE information Steph, now go and " sticky it " to the Failed Bands Forum please.

Done.

Hi. I'm going thru this issue myself right now. Here is my background. I had lapband for about 3 years. I didn't get stuck often, so I was unaware I was having damage. Well I lost weight with the band, but recently gained again. So I revised to the sleeve march 21st. That's when all my problems began. I had tons of scar tissue and a hernia repaired during my surgery. The following day I went for my leak test and spit up the barium swallow. The X-ray showed my stomach was swollen and nothing would go down. So I was in the hospital 6 days on fluids. I was released and able to do clear liquids after that. I threw up all the time but never really realized how much I couldn't keep down. So 5 or 6 days later I was readmitted again with sever malnutrition, dehydration and pneumonia. They installed a picc line so I could get nutrition thru a IV. They went to do a edg to dilate a stricture. I thought they had success but I still couldn't keep stuff down. So a few days later they repeated the edg again. This time they found a leak in my suture line. Uggggg The only positive thing I can say about the leak is that it's a very small leak and its contained. I don't think it's effecting my organs or anything. So again I went for a procedure,this time to put in a stent. After I woke up I asked how it went and they said they couldn't put in the stent because my esophagus was so dilated. They even thought of using multiple stents but didn't work. So my treatment now is letting the leak heal on its own. In the mean time I can't eat or drink for a month. Not even water. I am now out of the hospital and am getting home Heath care. I am staying with my aunt because she lives near my dr and I live 6 hours away. So at night I hook up to IV meds and my TPN nutrition. (I was in the hospital that time over 2 weeks so its nice to out) So I'm dealing with the leak, I hate not eating or drinking but ill manage. But I still can't hold anything down. Including my saliva. I spit and throw up all day. I spit up foam or I throw up mucus when it comes from the bottom of my stomach. I walk around the house with a bucket all day. I left the house for target the other day and had to carry a Starbucks cup to throw up in. So I know the leak will get better but I think my esophagus is ruined. I asked my dr about this yesterday at my appointment. He is hoping since I'm not eating or drinking it will go back to normal. I am worried it won't. It's already been a week and yesterday I had a X-ray to check my leak. I saw the X-ray and could see how huge my esophagus was. I didn't have any previous photos to compare it to but it's so big. My dr also used the term achalasia. So since yesterday I've been trying to google that. I saw from your article that vsg is a high pressure surgery. Since I already had that done that makes me worry it won't repair itself. I have a appointment next week but my dr is out of town and it will be a substitute dr so not sure if he will be even aware of my case. So in the mean time I will research more. Thanks for posting this information.
Jennifer

JJ, I know of another person who is in your exact situation. She's a member of our Failed Lapband and Realize Band group on Facebook. It's a closed and private group, so you can communicate with others in the same situation and get needed resources. PM me to give me your Facebook ID so I can approve you as a member, if you are interested.
My doctor says revision to VSG is out of the question for me.

Thanks for the info. I haven't been on this site in forever and can't remember how to private message someone. Can you message me and I can send you a reply maybe? I think I tried joining the failed lapband group yesterday but I believe it's pending approval, but I still have to look. I will post my story on both the failed and the realize boards to connect with some going thru the same thing. I'm doing fine and feel okay but am totally stressed that I will have to be on a feeding tube forever. Hopefully Minot the case. Thanks again, Jennifer