Question:
Bile reflux. 7 yr. post-of gastric bypass, needing partial gastrectomy due to bile reflux., HELP!

I had a distal gastric bypass 7 years ago. 4 months ago, I started experiencing severe lower (unused) stomach pain, diarriah, and passing large amounts of bile, blood, and mucus in my stool. Now, my Doc says I need to have a sub-total gastrectomy to fix this problem. I am just a little freaked out about going under the knife again, but know I can't take living with this bile thing much longer. They have called it duodenogastric reflux or DGR. Anybody ever hear of this, or had it happen? I am also concerned about weight loss after this next surgery. I am 150 at 5"10, and can't lose too much more for my taste, 25 pounds tops- no, I don't plan on being another Karen Carpenter. Please send help! Anyone who has any suggs, please, please, write. I'm very thankful for this site, I wish it was around the first time for me. Thanks, Sharon [email protected]    — Sharon S. (posted on October 1, 2000)

September 30, 2000
Hi Sharon, sorry I do not have any answers for you but I would like to hear more on this subject, too. I am pre-op just having received the referral to the surgeon. I was given an upper GI some time ago where it revealed reflux, hiatal hernia and a "giant duodenal diverticulum". I understand the role the hernia plays with that being at the base of the esophagus, therefore, it is a factor in GERD, however, duodenal (duodenum)is at the pyloric end of the stomach (bottom)where it connects to the small intestine A diverticulum is a sac. The fact that this is described on my upper GI as "giant" sure reassures me. Also the fact that all the gastro said was lose weight, pushed me out the door with a 1000 cal diet. If dieting worked I would not be this size, and I was looking for a referral for WLS. No explanation of why I had this, what it was...I looked it up in my Anatomy Coloring Book and Tabers. Nor any explanation of any treatment. I was referred there to be scoped and I was so disgusted with the doc I left and complained to my insurance about him. Because I have a new pcp and she gave me the referral to the WLS, which is what I really wanted, all along I just sort of figured that the WLS would correct my "stomach problems". Your post alarms me because you describe this as being duodenogastric which would be from the duodenal which is where I have the diverticulum. I absolutely want all the facts on this and what caused this for you. What the heck is this these days...another case where we have to be our own docs ... I thought the ignorance we face with the WLS and the lack of physician knowledge of that procedure and its benefits was astounding. Now I wonder about knowledge of other stomach problems. I know somewhat of what you deal with but not all...I have some of the same symptoms you have but not all, more of my distress is in the throat, the GERD, but wonder exactly what they plan to do to you. This surgery is technically described as "removal of a part or the whole of the stomach". If they are only taking the part that was originally bypassed I would think you would see little change in your weight. A plus, you sure would not have to worry about a disrupting staple line. I am not trying to make light of this situation. Have you been to a surgeon yet? What does the surgeon say? Exactly how much would they take and why did this occur? (I suppose this is one of those I don't know things) I know medicine is far from an exact science but I sure wish they would just lay it all out there in black and white, letting us decide or see our options. They keep so much information back and we have to probe so to find out things about our own functioning. I wish I had more answers to this. Best wishes ....
   — JennyLynn A.

October 1, 2000
I had the s/t/g in January. Oh boy, I wish it had been done originally! I had my distal gastric bypass 10/94 and must've had the tiniest ooze of acid all along. Water tasted nasty for 5.5 yrs. Couldn't stand pizza or tomato sauce, cuz it was too acidic. Peace and quiet has reigned in my pouch since then. My staple line had disrupted, so I'd gained 12#, of which I lost 15. Then floated right back where I've been. In your case, I wouldn't worry too much about much permanent change, just a slight fluctuation in your wt around the time of surgery when you're "off your feed". As you feel better and normalize, you should float back up where you belong. Just dont' panic when you dip a bit at first. Keep your protein level at peak or you may drop too much muscle of what you've got. If there's any danger of regain, you might want to ask 'em to make your pouch a bit smaller while they're in there.
   — vitalady

October 28, 2000
Dear Sharon, When the stomach is divided to make a pouch, and he largest portion of the stomach is left attached to the duodenum, which is the very first part of the small intestine, which is already connected to the outlet of your "old" stomach. The new pouch is connected up with the small intestine farther down, at the jejuneum, which is the name for the second segment of small intestine. Ten the duodenum is sewn back together near the same spot at th jejunum. Why? Because the pancreas, gallbladder, and a few other important organs are still connected to the old duodenum, up nearyour old stomaach. You need those organs and their secretions to digest and absorb your food. They just meet up with the food later on in its transit through your body, and the reduced absorption is part of the reason why you lose weight. Problem occur, though, when bile BACKS UP, undiluted by food, into the old stomach. It can be very irritating by itself like that. I'm not sure exactly how it can back up into the new pouch, but it is possible. The old stomach makes digestive juices and something called "intrinsic factor" that aids in vitamn B absorbtion (B12), so it is useful, too. But I wonder if it shouldn't just be taken out with a RNY, considering it is possible to have major problems with it, and it is VERY hard to scope after the surgery, which greatly limits the doctor's ability to diagnose/fix future problems without more surgery. I have heard that RNY is reversible, and also that it is not, from web sites published by MDs, and MD notes. Which is true? I don't know. My guess it is very hard to successfully reverse, due to cut nerves and so on. In which case, I wish they'd just take it out and give injectable B12.---Jesse
   — Jesse M.