Lurkers, Learn Here About Your Pyloric Valve (informative input from post ops welcome)
If pylorus remains:
one can drink with meals
one can eat 'tougher' meats
one can put a normal portion of food in the mouth and chew normally.
keeping the pylorus essentially keeps your stomach function normal.
No dumping syndrome
No stoma stretching (cause you keep your pylorus and do not have a man made stoma)
significant less risk of marginal ulcers, strictures
one can take NSAIDs
Dumping Syndrome
The two types of Dumping Syndrome are alternately discussed as a benefit or side effect of RNY. Early Dumping typically occurs 30 to 60 minutes after eating high concentrations of sugars or overeating. Because the pylorus is eliminated with RNY, the pouch can empty rapidly into the jejunum (the duodenum is bypassed). For reasons possibly connected to changes in blood flow and/or post-prandial release of gut peptides[i], patients experience a sudden and very unpleasant onset of symptoms including cramps, nausea and vomiting, explosive diarrhea, and dizziness, tachycardia, decreased blood pressure, and flushing. Early dumping is common in the first year after RNY and is promoted as behavior modification, since it is a very unpleasant response to eating sweets.
Late Dumping occurs one to three hours after eating, also in response to sugars or refined carbohydrates. Symptoms of severe hypoglycemia (sweating, tremors, exhaustion, decreased consciousness, fainting, hunger and sugar cravings) result from the efficiency of the small bowel in absorption of simple carbohydrate. This, in turn, leads to a hyperinsulinemic response[ii].
Dumping syndrome is reported in as many as 50[iii] to 70 percent of RNY patients.[iv] Dietary recommendations include reduction of sugar and refined carbohydrate, avoidance of fluids at meal times (to slow gastric emptying), and consumption of protein-rich meals[v]. The somatostatin analog, octreotide, can be used to control symptoms[vi] in extreme or refractory cases.
5 Carvajal SH, Mulvihill SJ. Postgastrectomy syndromes: dumping and diarrhea. Gastroenterol Clin North Am. 1994;23(2):261–279.
6Holdsworth CD, Turner D, McIntyre N: Pathophysiology of post-gastrectomy hypoglycaemia. Br Med J 1969 Nov 1; 4(678): 257-9
7Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–624.
8Pories WJ, Caro JF, Flickinger EG, Meelheim HD, Swanson MS. The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg. 1987;206(3):316–323.
9 Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Quart. 2003;26(2):133-138.
10 Gray JL, Debas HT, Mulvihill SJ: Control of dumping symptoms by somatostatin analogue in patients after gastric surgery. Arch Surg 1991 Oct; 126(10): 1231-5; discussion 1235-6.
www.youtube.com/watch
Keeping the pyloric valve in play allows for one to drink before, during and after meals. The valve regulates food and liquid differently, allowing liquids to pass while keeping solids to digest further into chyme before passing into the intestines.
While I'm eating, I AM LIMITED to how much I can drink because it is food I want to fill my belly with. I usually consume about 8-10 oz of fluids during a meal. But after dinner is a different story. I love having a large cup of hot tea every evening following my meal.
I am reliant on my pylorus knowing the difference between a steak and a cup of chamomile tea.
http://www.aic.cuhk.edu.hk/web8/gastric_emptying.htm
Gastric emptying
Claudia Cheng
updated in August 2006
Introduction
Stomach emptying is a coordinated function by intense peristaltic contractions in the antrum. At the same time, the emptying is opposed by varying degrees of resistance to passage of chyme at the pylorus. Rate depends on pressure generated by antrum against pylorus resistance. Chyme = food in stomach which has been thoroughly mixed with stomach secretions
Factors affecting stomach empyting
- Promote
§ Gastric volume
o Increased food volume in stomach promotes increased emptying
o Antral distension stimulates vasovagal excitatory reflexes leading to increased antral pump activity
§ Liquid vs solid food
o Clear fluids are empty rapidly (T1/2 » 30 minutes). Solids stay in stomach longer (T1/2 » 1-2 hours)
o Pylorus is open enough for H2O/fluids to empty with ease. Constriction of the pyloric sphincter to solids until chyme is broken down into small particles and mixed to almost fluid consistency
§ Types of food
o Protein empties fastest, followed by carbohydrates. Fats take longest to empty
o Note: high protein food especially meat stimulate release of gastrin from antral mucosa
§ Hormonal factors
o Gastrin has mild to moderate stimulatory effects on motor functions in the body of the stomach. Enhances activity of pyloric pump
o Motilin released by epithelium of the small intestine enhances the strength of the migrating motor complex which is a peristaltic wave that begins within the oesophagus and travels thru the whole GIT every 60-90 min during the interdigestive period. Help empty remaining food in stomach
§ Neural
o Parasympathetic innervation (via vagus) stimulates motility
o Local myenteric reflex
§ Drugs
o Prokinetics eg cisapride, erythromycin metoclopramide
- Inhibit
§ Duodenal distension
o Results in inhibitory enterogastic reflexes
o Slow or even stop stomach emptying if the volume of chyme in the duodenum becomes too much
§ Osmolarity of chyme
o Iso-osmotic gastric contents empty faster than hyper or hypo-osmotic contents due to feedback inhibition produced by duodenal chemoreceptors (hyper more inhibitory than hypo)
§ Types of food
o Fat and protein breakdown products in the small intestine inhibits gastric emptying
§ Acid
o pH of chyme in the small intestine of < 3.5-4 will activate reflexes to inhibit stomach emptying until duodenal chyme can be neutralized by pancreatic and other secretions
§ Temperature
o Cold liquid (40C) empty more slowly
§ Hormones
o Cholecystokinin released from duodenum in response to breakdown products of fat and protein digestion. Blocks the stimulatory effects of gastrin on the antral smooth muscle
o Secretin released from the duodenum in response to acid, has a direct inhibitory effect on the gastric smooth muscles
o Others eg somatostatin, vasoactive intestinal peptide (VIP), gastic inhibitory peptide (GIP)
§ Neural
o Sympathetic nerves (via the celiac plexus) inhibits motility
§ Patient factors
o Pregnancy delays gastric emptying (progesterone)
o Anxiety delays gastric emptying
o Pain
o Elderly
o Disease states eg diabetes mellitus (autonomic neuropathy), post-operative bowel surgery with resultant ileus, high intra-abdominal pressure
§ Drugs eg. opioids
§ Mechanical eg pyloric stenosis
?Claudia Cheng August 2006
