Question:
Post-Op 7 years...Had Endoscopy done and GI Dr. says I have "NO POUCH"

So, I have had really low iron levels and my gastric bypass surgeon wanted to check for ulcers, so he sent me to a GI doctor. After the endoscopy, GI doctor told me I have no ulcers (thankfully) but I also have no pouch. He says I have an esophogus and a tiny connection of "stomach" that goes straight into my intestines. Is this possible? Can this be the reason I have really low Iron levels? Do you think maybe the lack of stomach pouch and obviously lack of stomach acids is preventing me from absorbing any vitamins? I'm SO freaked out. I got a followup appointment with my surgeon, but not for another month. I don't know what to do. Please let me know if any of you have had this issue and any feedback you have. BTW, I can eat as a normal gastric bypass patient this far out. Not too much but not a tiny bit either. About 1-2 cups depending on how hungry I am and what I'm eating. I don't throw up or anything...Everything else is pretty normal...    — lowcarbinchica (posted on March 17, 2009)

March 17, 2009
I am always low in iron and have taken iron every day for years before and after gastric bypass. Have you tried taking extra iron?
   — Carlyn M.

March 17, 2009
absorbing iron is very hard. The iron is absorbed in the intestine so the lack of a pouch should not be a big concern. Just take additional suppliments and be sure you take it with b12 so you absorb better. Keep us posted on what they tell you. I will be praying for you.
   — trible

March 17, 2009
Hi....my major worry right now is the fact that my GI doctor claimed I have "NO POUCH!" That's a major problem for me.... In regards to my iron deficiency, I most likely will need an iron transfusion on a yearly basis to keep my levels up. :(
   — lowcarbinchica

March 17, 2009
I am a physician but not your physician so talk about this report from the GI doctor with your surgeon. That said I get the impression this GI doctor is not familiar with wls patients. The connection of the intestine to the remnant of the stomach at the end of the esophagus IS the pouch. The fact that you are eating 1-2 cups means your pouch has adapted after surgery. Don't worry about the GI doctors opinion the only thing important that he said was that you have no ulcer therefore that is not a cause of your iron deficiency. I agree with the above posts that you are probably going to need agressive iron replacement because once you get behind it is hard to catch up. Talk with your surgeon and nutritionist on how to get caught up and what supplement to take to keep up in the future. Dont freak out it sounds like your surgery is fine you just have a common deficiency that needs to be addressed.
   — hapkidodoc

March 17, 2009
Thank you all for your feedback. In regards to the GI doctor, he is the one that my gastric bypass surgeon always refers patients to so he's very well familiar with the technicalities of the gastric bypass patient's anatomy. He printed out 4 pictures for me illustrating that I have "no pouch." (I can send it to you, if you have a minute to look at it)...He seemed really alarmed about it as he hadn't seen that before, he claimed. I was too drugged up to be coherent so I couldn't discuss then. I guess I will have to wait until next month's follow up with my gastric bypass surgeon. I will try not to freak out. LOL
   — lowcarbinchica

March 17, 2009
Dr. Flowers said something very important. That is that our PCP's need to know about WLS. My surgeon gave me a big informational packet to give to my PCP. It listed different problems I may have in the future and how they could be related to the surgery. It was written in MD words so I didn't understand a lot but I appreciated the info for my docter and I'm sure she did too.
   — Muggs

March 18, 2009
I was anemic last year...and did a ton of research to get out of having to have blood transfusions and iron infusions...And I found Carbonyl iron is a GREAT RNY absorbable iron and is non-toxic in very high doses...I attacked my anemia aggressively and took (Chewed) 325 mg of carbonyl iron daily with VitC as ascorbic acid...(It doesn't have a metallic taste at all...Vitalady has a chewable form Called "Tender Iron"...It is wonderful! I orer mine from her for a year now.... I swear by it. It saved me!( I was on bed rest for 2 months!) Plus I take 2 mg copper capsules as copper aids in iron absorption...I raised all my low blood levels in two months and my ferritn climbed from 5 to 16 in two months...At 6 months my iron was nice and high and I was able to cut back my iron to 200mg a day...It has NO side affects on me as with ferrous sulfate or other iron salts which are USELESS to the RNY anatomy...I was told I would never get out of anemia on supplements alone....No one can tell me "never"...That word is not in my vocabulary! Carbonyl iron is even safe for CHILDREN...AND YET is absorbed 20% better than Iron salts according to scientic studies! The studies were done 20 years ago and again recently...and in VERY high doses of 2000 mg! There were little side effects and no toxicity reported! That much iron in iron salts could kill someone, especially a small child! Recently Bariatric Advantage has switched it's formula to carbonyl as well and I bet it won't be long now before the FDA changes even our iron enriched foods from ferrous sulfate to carbonyl as well! It's already happening. It's not a well known iron with most doctors...but if you are serious about helping yourself...do some research and get on carbonyl iron! EVEN if you must initailly have iron infusions...MAKE your doc look at carbonyl iron...INSIST...It's helped me and soooo many others that have discovered it as well!
   — .Anita R.