Coughing at Night

This week I saw two patients in the office who complained of reflux and coughing when they laid down at night. Both had had an adjustable gastric band placed a few years ago and had not had a recent adjustment to there band.

Their symptoms are related to the band being too tight causing back up of saliva in their esophagus. When they lay down the pooling of saliva can overcome the ability of the muscle at the upper end of the esophagus to keep the saliva out of the throat.

When the contents of the esophagus come up into the throat it they can come in contact with the vocal cords and cause coughing. Occasionally this will aspiration of these contents into the lungs and cause pneumonia.

This problem is usually rectified by taking some fluid out of the band.
In both cases this immediately relieved the symptoms in both of these individuals and they were able to drink water comfortably.

Although this solved the immediate problem, band slippage could be the reason this has only recently developed.

If the problem recur rs with or without placing more fluid into the band the patient should be investigated with a special X-ray such as an upper GI or a CT scan to determine whether slippage has occurred.

If the band has been forced to slip down further on the stomach the band may have to be repositioned with another laparoscopic operation. Hopefully this will not be the case for either of these individuals and they will be able to avoid another operation. I will be seeing each of them in the office again in a few weeks for follow up.