GERD & the DS

Hey all!

So I've read old forum posts about the DS and GERD.  I have to revise my surgery (VSG) this year regardless, but due to GERD it may have to be the RNY (we'll see what the EGD says at the end of October.)  I have read studies about the DS resolving pre-op GERD.  

I was wondering how many of you have GERD a few years out from surgery.  I would prefer to get the DS as was the original plan over a year ago, but I will get the RNY if indicated.  We'll see how it goes.  I didn't have GERD pre-op, so chances are if something other than the sleeve is causing it I still might be able to do the DS.

I was wondering what DS vet experiences with GERD are several years out from surgery.  I was also wondering if anyone knew of long-term studies for the DS and GERD.  I have one I read by Dr. Prachand from the University of Chicago, but I'd love to see more.

Hiatal hernia's cause GERD too, and if that's the problem and it gets repaired, then problem solved!  I'm 11 years out from my DS, and no problems here at all.

I'm hoping to make the argument for that.  Getting the SADI/SIPS is an option too, but it makes me nervous that there's such a lack of research.  I also don't want to deal with bile reflux after this GERD, and I guess it has a higher chance of causing it.

Donna, if/when someone has a problem with GERD with the DS, it's from the sleeve part of the operation, not the "switch" part. Since you already have a sleeve, I don't see how getting the switch added would make GERD worse, and having SADI instead of DS would not improve your GERD since the sleeve part would be the same. And you are right about there being a lack of knowledge about the long term results of SADI, as well as the potential risk of bile reflux, which does not exist with the DS.

I had the DS over 10 years ago. I do have GERD, which is well controlled with one prilosec daily. Even though the prilosec is extended release, which often doesn't work well with the DS, it works just fine for me. And of course, while you are in surgery, as Val pointed out, if you have a hiatal hernia your surgeon can repair this for you at the same time as doing the switch.

I would only recommend gastric bypass as an alternative for someone with GERD if their GERD was severe. Then it makes sense, Otherwise, you would be having an operation with inferior results for percentage excess weight loss, for maintaining that weight loss (a big problem with gastric bypass) and inferior results for permanent resolution of ALL comorbidities except GERD.

Larra

See, my concern with the RNY is exactly tied to what you mentioned, Larra.  I am a "problem child" as I tell my surgeon, lol.  it's complicated because my highest weight was not my surgery weight below, but over 750 pounds at one point.  I have kept it off, but I am not sure the RNY will take me the rest of the way.  Maybe it will?  I have three autoimmune diseases too, though, as well as binge eating disorder.  My metabolism is shot even without having been super morbidly obese..  Don't get me wrong though, my health has drastically improved since the VSG despite the crummy GERD (I had immediate diabetes remission, was lucky).  The VSG saved my life and made it possible to complete grad school while working 70 hours a week.  I am grateful for it to be sure.  I still want to be close to 150 as I can get though!

I have a very small hiatal hernia, but I am also at least still 150 pounds overweight (I'm at 292 today, and I'm only 5'1').  I think it's a combination of obestiy + the hernia, not the sleeve on its lonesome.  My surgeon did his residency at the University of Chicago years ago by the guys there, so he knows his stuff.  He is concerned with the DS side effects and said if the GERD isn't a factor he is contemplating suggesting the SADI more.  I am basically compiling surgical studies and am going to talk to him very informed.  The people I've talked to who have the DS (including some clients I saw with it) have all said the side effects it is known for are minimized if you eat properly.

Also, after having taken Hala's advice to eliminate food, my GERD reduced when I drastically pared down my dairy intake.  It makes me sad, but I may also need to go off whey and my dairy. If it helps at this point I am not complaining though!

Thank you for your reply :)

There is nothing that will help you more than the DS.  Period.  And the GERD/acid issues you talk about are caused by the sleeve, not the switch.  And since you already have the sleeve, you are good to go.  Plus you already have 1/2 the DS so why even consider something else that isn't proven to work as well as the DS?

Because it depends whether the GERD is caused by the sleeve or not.  Revising to a DS will not fix the GERD, necessarily, depending on the sleeve and/or what else may be going on.  They are going to do an endoscopy to check it out and biopsy for other stuff.  If it's severe then it is suggested I get the RNY.  The only reason I'd do anything other than the DS is to treat my GERD.  I am basically building an argument for DS revision despite having severe GERD to bring with me to surgeons.  

I agree 100% about the DS.  It has always been the ultimate goal.  I personally don't want to consider anything other than the DS (indeed that is why I have a VSG to start off with, because my health was poorer and the intention was to revise).  My surgeon has done many revisions, too.  We are waiting to see what the endoscopy says at the end of the month about the GERD.  It could still be other things.  They are also checking for Celiac and other possible causes for damage in the duodenum.

The problem is I have severe chest/stomach pain and no gallstones.  Like, pain bad enough to be in the ER.  Everything else has been ruled out except for GERD and a few other confounds.  So, we'll see if it's the sleeve causing it, and/if it would be resolved by the hernia repair plus the weight loss from the DS.  I am collecting as much clinical research as possible to provide empirical evidence that the DS is still appropriate despite the GERD for other reasons.

If the GERD ends up being the reason and is acute, I may have no choice.  I have friends who are surgeons who have suggested the same thing.  Generally the DS is counterindicated for GERD patients.  I am still getting second opinions, of course.  Fortunately, I live in an area with a glut of DS surgeons, and one university center which is accustomed to doing revisions.  My own surgeon thankfully puts up with my intellectual nerd side (I have a background in clinical research) so we will see what he says if I am able to find evidence to support what I want to do.  So far there are fewer studies than I figured, though.

If you used to weigh 750 pounds you need the d.s. Btw, d.s surgeons (some of them anyways) have some creative ways of helping GERD. I am going to have one try to do a dor fundoplication on me. Granted, it's not definite that I have enough of a fundus left to do this tiny fundoplicaton but it is an option that I want to pursue rather than just going for the RNY. 

Thanks, Mai!  I am actually not sure how large my fundus is remaining (if any).  I have my surgical report somewhere.  However I will see the surgeon in November immediately after the endoscopy to talk about options.  I will definitely talk to him.

Honestly, I'm willing to put up with some GERD.  Yes, I know it can cause cancer potentially.  And yes, it can be dangerous.  But I also know staying obese is worse, IMO, anyway!

I spoke with my surgeon last week about the fundoplication.  He told me it's about 80% effective, which is a good percentage for medicine. Well, 20% failure is not a small enough number for me.  Like you, I am also a problem child!  If it can happen, it will happen to me.  You've come so far.  I'm hoping you get the answers you are looking for in a timely manner.