Rachel Moore, MD

The muscle that you breathe with, your diaphragm, has a hole in it that your esophagus traverses as it goes from your mouth to your stomach. The medical term for this hole is the "esophageal hiatus." When the esophageal hiatus is larger than it should be, your stomach can ride up into your chest, which is defined as a hiatal hernia. Large hiatal hernias are a contraindication for Orbera intragastric balloon. Your doctor may need to do surveillance endoscopy to evaluate the size of your hiatal hernia before she can advise you if you are a candidate for Orbera.

There is no set protocol for the amount of fluid added to an adjustable gastric band at an office visit.  The provider will speak to you about your weight loss and any symptoms and use their clinical experience to decide what to add or remove.

A BMI of 39 has several treatment choices.  You're in the range for the Orbera Intragstric Balloon, Lap-Band, or Sleeve Gastrectomy.  Few patient lose 80 pounds with Orbera, so if that is your goal you should take a closer look at band and sleeve.

Gastroparesis causes the stomach to empty poorly.  When someone needs to loose weight and loss has gastroparesis, the tried-and-true approach is laporascopic roux-en-y bypass.  There are a couple of surgeons doing sleeves for gastroparesis as part of a research study but this new and long term results are not available.

Alcohol and other liquids can be tolerated immediately after gastric bypass.  Caution is important because it is a high calorie liquid and its consumption can impair your weight loss.  Data also suggests that intoxication occurs after a smaller amount is consumed and in very rare cases, patients struggle with "substitution of addiction" and abuse alcohol in place of food.  Gastric bypass is a very effective treatment for weight loss and putting medical conditions, especially type 2 diabetes, into remission.  Best wishes for improved health!