How long does liquid stay in new pouch after drinking it?

califsleevin
on 9/23/19 10:04 pm - CA

Somewhere between the gastro and the surgeon lies the answer. Some of the tests that the gastro may want to do may not be that pleasant, but the data is needed to come to a proper diagnosis as to what is going on in there, which leads to your treatment options. The gastro is most likely to be able to help you with whatever medications and living adjustments may be needed to address the problem; if a surgical solution is needed, then the surgeon comes back into play. The RNY does have some predisposition toward bile reflux (much as the VSG has some predisposition toward acid reflux), and making adjustments to the limb lengths usually does the trick. The DS is about as safe from bile reflux as can be, but few surgeons can do that revision so that is not usually considered; the distal RNY would a second choice, but you may not need that extreme malabsorption, but there is likely a compromise between the typical proximal RNY that is normally done and the more extreme distal configuration that will do the job for you (if surgery is a needed step.)

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin

 

White Dove
on 9/24/19 6:12 am - Warren, OH

RNY does take care of bile reflux, but it is possible for it to come back. In my case it was too much spicy foods. Baking soda calmed it immediately. Cutting out the spice took care of it permanently.

Real life begins where your comfort zone ends

califsleevin
on 9/24/19 6:03 pm - CA

Are you sure that you aren't confusing acid reflux with bile reflux?

Yes, RNY usually takes care of acid reflux owing to its keeping the majority of acid production in the remnant stomach and away from the esophagus, though as you note, it can recur or start fresh with some patients.

Bile reflux is something of a predisposition with the RNY, as it is with most any of the billroth II style of stomach resection, as the stomach access is moved downstream of the bile ducts, and the pyloric valve is removed from the system eliminating another resistance point. In a typical RNY for weight loss, most surgeons work toward the legal limit and the limbs are usually left long enough to avoid the problem; it is more common when the limbs are short in order to minimize weight loss, such as for gastroparesis or cancer treatment, but can still happen with the RNY due to individual patient quirks or surgeons' techniques. This is also why the mini-bypass is more prone to bile reflux than the typical RNY - the distance between the bile ducts and stomach outlet is fairly short - and why the DS is the best solution as it is difficult to get that distance any longer (the bile secretions have to go down several feet of intestine before turning a corner to go back upstream several feet to reach the pyloric valve.)

If baking soda is solving your problem, then it isn't likely bile reflux, as it doesn't do any good to use a base to neutralize another base. What often happens when one has a reflux incident, the stomach contents are refluxed up into the esophagus (and sometimes beyond) and when it recedes, some of the digestive enzymes, such as pepsin, are left behind, attached to the mucosa, which they think is just another piece of meat to digest. As they are normally resident in the stomach, they thrive in an acidic environment, and as long as they continue to get bathed in acid, either from reflux or from an acidic diet, they are kept happy. This is why a low acid diet and particularly some alkaline intake (your baking soda in water, or any of the commercial alkaline waters) provides relief, particularly if the reflux events are relatively rare.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin

 

White Dove
on 9/24/19 9:43 pm - Warren, OH

That is interesting. It has happened a few times, probably less than five and several years ago and baking soda calmed it down immediately.

Real life begins where your comfort zone ends

califsleevin
on 9/24/19 10:20 pm - CA

It sounds like just the "normal" occasional reflux that any of us (pouch, sleeve or even "natural" stomach) can get from over eating or the traditional spicy or reflux inducing foods. The few references that I have seen to esophageal cancer after RNY were pinned on chronic overeating - consistently stuffing the pouch to the extent that the esophagus became an "overflow stomach" and suffered as a result. The occasional insult isn't something to worry much about as it can be treated as a "normal" person would - with Tums or Pepcid, or as you have done with baking soda. If it is a chronic or daily problem as the OP is experiencing, whether from bile or acid, it needs to be investigated to find a cause and appropriate course of treatment.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin

 

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