Bile reflux, plus other fun things

Good morning DSers!

Love how I keep coming back here. I'm just about 9 months post SADI and it's been a journey!

A few weeks ago I started having GI symptoms including pain, cramps, and nausea that progressed down from chest pain every morning. After reporting it to the surgeon a couple of times, they ordered an EGD, which diagnosed only moderate bile reflux. Leading up to the procedure, eating resulted in so much pain I'd eased back to soft foods, and then to just protein shakes. In the last month, I've lost over 20 pounds, which is more than any other month since surgery, and more than the prior three months ccombined.i should note that even on other foods, I was getting enough calories that this loss is unexplained.

The pain got pretty bad, so I used a couple of post surgery painkillers to be able to sleep. I woke up last week with my fatty tissue on fire. It still is, and the area is spreading. My clinic is treating the new pain completely separately and has referred me to my PCP for that.

For the reflux I've been prescribed ursodiol and levsin. The surgeon's office told me if the symptoms don't clear up in the next ten days (it will have been about a month, then), that his next suggested step would be to revise to a full DS, which I'm not interested in doing. Also unclear how that would help correct bile reflux.

Anyone had bile reflux and resulting unintended weight loss? Would love to hear how it was treated.

A small part of my brain has been worried about a blockage or something more serious because of how much pain eating causes but my clinic seems to have discounted that completely.

I'm trying to stop losing, and trying to figure out the GI and neuropathic pain. Would appreciate any stories or experiences you guys can chime in!

Cheers!

There have been some who coming through here who have had bile reflux problems with their SADI (and its cousin, the mini bypass) as that is one of the potential side effects of those simplified configurations (take a look at the anatomy diagram and see how the stomach empties into the intestine downstream of the bile ducts, which are normally downstream of the stomach in the natural anatomy. With the traditional DS, bile secretions have to go down the entire bypassed channel, several feet, to the anastomosis at the start of the common channel, and then back upstream several feet to get back to the stomach. That's why bile reflux is all but impossible with the traditional DS. (The added limb between the stomach pouch and mainline intestine on the RNY serves the same purpose, if it's long enough, which is why bile reflux is fairly rare with that, compared to the single anastomosis procedures.) There's always trade offs! I'm not familiar enough, experience wise, with the SADI to speak with any authority (the surgeons we have been associated with only do the traditional DS and VSG, so no direct patient experience in our support group to draw from,) but perhaps the limbs can be moved around some to further distance the stomach from the bile ducts; there is allegedly some minor technique tweak for the mini bypass which is supposed to reduce the incidence of bile reflux, so perhaps there is an analogous tweak for the SADI (or maybe that's just marketing hype.)

I don't know who your surgeon is (reassuring that they are suggesting the traditional DS, inplying that they know how to do it!) but perhaps a second opinion from another SADI surgeon would be useful. I know Mitch Roslin in NYC has been a big promoter of the SADI as a simpler, more accessible alternative to the traditional DS, which he also does, and seems to have done a lot of development on it - perhaps a phone consult could be useful?

Thanks for this feedback and perspective! Yes, he knows how to do a traditional DS but their office doesn't offer it as an option because of the increased risk of health issues. It's part of why I'm surprised that's the solution they've come back with. Appreciate you sharing the info on the surgeon in New York. It can't hurt to ask, even if it would be out of network for me to use any other surgeon for a WLS procedure. GERD was definitely mentioned but I don't think bile reflux was discussed, so that's something to be aware of.

Your explanation for why a revision would work is super helpful. Thank you!

Sadly, this has been since my gallbladder came out, so I'd guess it's related. I'm hoping there's a way to attempt to treat it medically, first. Not exactly willing to jump back on the table for a third surgery in under a year.

Either way, appreciate you weighing in!

I was given a Sadi instead of the DS I asked for several years ago. I developed bile reflux, which can be a side effect of that surgery. I think it can come down to the skill of the surgeon snd doing the surgery properly, also, in my opinion. I was also having acid reflux at the time which was a double nightmare.

I was given a medicine to absorb the bile. I want to say it was questran but can't remember. It was of course a temporary fix.

I eventually had to have the original DS snd the bile reflux went away. I'm afraid that's the only cure for it.

That sounds terrible. I'm sorry you didn't get the surgery you thought you were getting. I've seen you advocating here for people to be very proactive about those questions. I can't imagine dealing with acid and bile reflux concurrently. Shudder. Glad the DS addressed it for you.

They have not prescribed that medication. I was given ursodiol and something to calm the GI spasms I'm having. When you had the fluxes, did you have inclusion through the whole GI tract? I'm back feeling like I'm just post surgery in what I can eat and drink. Everything causes cramps and issues further down, which I didn't think was related to reflux.

Thank you for chiming in!