How does the band affect reflux and heartburn?
A. The heartburn you have right now is caused by reflux of gastric juice up to the esophagus. The acid in the gastric juice is not produced in the whole area of the gastric mucosa. It is produced in something called parietal cells. The upper limit of presence of these cells is about 2 inches from the gastro-esophageal junction. The band is placed above these cells. This means that the band actually prevents acid from running up in the esophagus. The second factor of importance is the hiatus (the opening in the diaphragm through which the esophagus goes up into the thoracic cavity). In most individuals the hiatus is tight and no gastric juice is allowed to pass up into the esophagus. In many obese individuals the hiatus muscle becomes slack – so reflux is actually a complication to obesity. When we perform gastric banding we usually tighten the hiatus muscle with a couple of sutures. The result of both these factors is those obese patients who have esophageal reflux in most cases experi
