What are the causes of esophageal spasms after lap band surgery?
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The lap-band is a popular surgical implant used to treat obesity. An adjustable ring encircles the stomach just below the diaphragm and reduces the amount of food a person can eat before feeling full.
After surgery, some patients suffer esophageal spasms, which are involuntary muscle contractions of the oesophagus that can cause severe pain and disrupt the travel of food to the stomach. The cause is unknown, but there are certain triggers patients can work to avoid.
Esophageal spasms can vary from uncomfortable pressure to extreme pain that radiates through the entire chest and back. These spasms fall into two categories: diffuse esophageal spasms (DES), irregular contractions of the oesophagus which can stop food from reaching the stomach, and nutcracker spasms, which are painful and extremely powerful versions of the normal smooth, coordinated muscle movements of swallowing. Spasms severe enough to prevent a person eating or drinking enough can be dangerous as they may lead to malnutrition or dehydration.
The exact cause of these spasms is unknown, but they may be linked to a disruption of the nerves that control the swallowing process. Why some lap-band patients experience spasms and others do not is a mystery, but there are some identifiable factors that may contribute to them.
Irritation of the stomach or oesophagus seems to be the key trigger for esophageal spasms. This irritation can be from a physical shock, such as eating very hot or very cold foods, or from pressure on the oesophagus or diaphragm. Eating even slightly more than the stomach comfortably holds can result in enough pressure on the diaphragm to cue spasms. Food that is not chewed sufficiently can be too large to fit through the small opening of the lap-band.
When this food gets caught, it causes extreme discomfort and regurgitation, which is when the muscles work to push the food back up the oesophagus in a motion similar to vomiting. Some fruits and vegetables, like grapes, tomatoes, peaches, or apples can cause blockages, and therefore overfilling and regurgitation, because their skins may not be broken down enough by chewing. A lap-band that is adjusted with an opening too small increases the frequency of obstructions and will cause solid food to bump up against the diaphragm as it would in overeating.
Chemical irritation from acid-rich foods or acid reflux can also trigger spasms. Foods like citrus fruit and tomatoes can be acidic enough to irritate the stomach or oesophagus. Anxiety, which can cause the stomach to produce too much acid, and gastro-oseophageal reflux disease (GERD), when stomach acids and/or bile regularly backflow up through the stomach into the oesophagus, both increase risk of experiencing a spasm.
Esophageal spasms can be soothed by many of the treatments for GERD, including antacids and diet modification. Peppermint oil and controlled breathing techniques have been known to help smooth the muscle contractions. In severe cases, doctors can prescribe medications or Botox injections to paralyse the nerves which cause spasms. Surgery is used only in extreme cases.
Anything that can irritate the oesophagus or stomach can be a trigger in people who suffer esophageal spasms. The best way for lap-band patients to avoid them is to carefully follow their surgeon’s or dietitian’s food guidelines, including eating slowly, chewing food thoroughly, and measuring portion sizes. Avoiding very hot or very cold foods and highly acidic foods as well as peeling skins of fruits and vegetables can also help minimise stomach reactions.
- Tom Le Goff/Digital Vision/Getty Images