The Pyloric Valve-How it works with the VSG

 

First, I’m not a doctor nor have I ever played one on TV.

This may be old news to some..... But I’ve noticed a lot of people who have had VSG do not have any idea how the Pyloric Valve works.

This is my understanding how the Pyloric Valve works.

The Pyloric Valve function and how it pertains to your VSG.

The function of your Pyloric valve is the single most not talked about important part of understanding how and when you should eat and drink.

The Pyloric Valve is just that....It is a valve that is located at the bottom of your stomach/sleeve. This valve is in between your sleeve and the lower intestine. The basic definition of a valve is an apparatus that opens and closes.

When open this valve it is about the diameter of a dime. When closed it’s opening is closed down to the diameter of the head of a ballpoint pen.

Dense proteins and harder to digest foods will cause the Pyloric valve to close to hold the food in your stomach for pre-digestion...... stomach acids breaking down this “Rough" food. 

That’s why we are told to eat dense proteins first.....To close the Pyloric Valve so food stays in your stomach/sleeve longer so we have a sense of satisfaction.

It takes about 30-60 minutes for the food to clear the Pyloric Valve...... Than it’s OK to drink.

That is also where the term slider food  comes into play. A slider food does not close the Pyloric Valve and as the term is intended.....food slides right past an open Pyloric Valve.

There is a video that gets posted every so often that is supposed to explain food going past the Pyloric Valve. The guy uses a funnel and has apple sauce or something in it....and it shows the apple sauce dripping out the end of the funnel very slow. Than he pours water on top of the apple sauce to dilute it, illustrating drinking after eating.....and the diluted apple sauce runs through the funnel end faster. Than he concludes that this is how your pyloric valve works.

Well, it is a great video that only tells half the story.....remember it’s a valve...and he is only showing it in the open position....

So now the other half of the Pyloric Valve function..... You eat a dense protein like chicken that causes your Pyloric Valve to close. Say for example your sleeve has a 4oz. capacity.....and you eat 4oz. of chicken.....your sleeve is full and holding all 4 oz. of chicken for pre-digestion because your Pyloric Valve is closed. 

So now try and drink something....where is it gonna go? Up.....Up until it hits another valve of sorts..... the Esophageal Sphincter (valve) and above that is a flapper valve. The function of these two valves is to hold food, bile and stomach acids in your stomach and not backing up into your air way. This is a very high pressure system. Thats why when you eat to much or drink after eating a hard to digest food and your Pyloric is closed.....It hurts cause you pressurized your intake track. Vomiting would be a natural pressure release.

So you can see how learning and understanding how the Pyloric Valve works is important as it pertains to eating and drinking with a Gastric Sleeve.

So that was kinda like VSG and the Pyloric Valve 101

As you get further a long you will want to use the Pyloric Valve in other ways to keep food in your sleeve longer to stay satisfied longer. 

A sleeve empties faster than a stock un altered full size stomach so sometimes it’s beneficial for you to learn what foods stay in your sleeve longer to extend satisfaction.

Dense proteins are #1 in closing the Pyloric Valve. Chicken, steak, pork, fish.....in that order seems to be the way it goes for me.

Other foods that are hard to digest and help close the Pyloric Valve are foods like:

• Broccoli Stalk
• Asparagus
• Celery
• Cucumber with Skin
• Radish
• Cabbage (I’m testing this right now)
• Bell Pepper

So I hope you understand my 5 cent tour of the Pyloric Valve and how it effects the way we eat with a VSG and how important it is to work the Pyloric Valve to your benefit.

frisco

 Thanks for this! I've been trying to explain this to my family for weeks now and they just don't seem to understand what I am trying to say. I'll be printing this out and showing it to them. :)

Thanks for explaining! There is so much misinformation out there. I can't tell you how many times I have read on the board over and over that liquid just "passes through" but from what you are saying it doesn't necessarily if there is food in there.

Thanks, Frisco.

I have seen people post that apple sauce video too. The man in the video even says this is for RNY and LapBand, but people still seem to be confused that the VSG works a little differently.

I have learned some of this before and have read your posts on this before, but I do get confused because there is a pyloric valve post that makes it on the MB from time to time which states that keeping the pyloric valve should allow for eating and drinking at the same time and then my head gets fuzzy.

My NUT was teaching a generic class to all surgery types and told a story of an RNY patient who didn't lose much weight past 2-3 months and when they broken down the behavior, they found she had continued to drink with her meals which allowed her to eat more. This story stuck with me and I have avoided drinking with meals as instructed by my surgeon/NUT and by now it has become such a habit that it is no big deal...Plus I usually want to use that room for the steak or chicken or crab I'm eating!

Thanks again,
Lindsey

From some of the studies I've read on transit time.. in a normal stomach, the addition of liquids with foods can speed gastric emptying by around 20% max. With the sleeve, some folks find they have a little faster transit time, so those numbers may be higher for us.. You are correct, that vid is to show how a stoma works, not the pyloric valve, no disrespect towards Frisco. It was explained to me that the no eating and drinking rule was mostly due to space limitations, with a nod to possible faster gastric emptying times.

 
That makes total sense that fluids can speed up transit time.... I think my concerns have been more of space......personally..... the few times I've tried to have coffee or tea or water after eating.... it was a couple of sips and stopped.....cause it just didn't feel like it was going down......

frisco

Yep. I can't physically drink with my meals.. save the sip or two I need to pop a vite in. But, the valve does allow fluids to pass slowly, while keeping he chyme in until it is sufficiently processed. It's mostly a space issue, with a possible faster emptying issue for some.. Stomas are a separate animal entirely, and I am very happy I still have mine (edit, my pylorus!) in place! Either way, space is limited- fluids can wait most times!

 
Jo,

I should have really elaborated on that......The Pyloric is a GREAT thing.....I to am glad I have mine....

I guess my real emphasis on this post should have been more to learn how to work "with" your Pyloric Valve....not against it cause it has a great function and a lot of people get in trouble with it and/or don't use it properly.

frisco

Thanks Frisco, very informative.  

 Thanks Frisco!  I knew this, but always good to have a reminder.  I gotta say, at 4 months sometimes it takes 1.5 - 2 hours to feel up to drinking!  Luckily I can drink quickly now, but wow for a full feeling to last that long is amazing!