Purpose: A 33-year-old female with prior laparoscopic adjustable gastric band (LAGB) in 2010 for morbid obesity (BMI before surgery=34.5 kg/m2) presented with vomiting, epigastric pain, odynophagia, and heartburn without melena during the past 3 weeks. She had a similar episode 1 year earlier that resolved by removing fluid from her adjustable band. Physical examination revealed only mild epigastric tenderness. Routine blood tests showed no abnormalities. Abdominal roentgenography revealed the adjustable band mostly inflated in the proper position (Figure 1). Esophagogastroduodenoscopy showed multiple acute linear ulcers with surrounding erythema arising from the GE junction and extending proximally 8 cm, highly consistent with reflux/emetic esophagitis (Figure 2). Pathologic analysis of distal esophageal biopsies showed acute and chronic inflammation without Barrett's esophagus. Her bariatric surgeon removed 8 mL of fluid from the LABG to loosen the gastric band. The patient subsequently did well without further nausea, vomiting, or abdominal pain. LAGB, is a popular, minimally invasive bariatric procedure that involves placement of a band around the gastric cardia. This band is adjusted by inflating or deflating with saline, to constrict or restore patency of the stomach outlet. If the band is too tight, chronic reflux and regurgitation can occur. This case characterized the endoscopic appearance of the esophagitis from an overly restrictive adjustable band.FigureFigure