BILE from Laurie's Husband

[Guest guest]

Hi !! I'm the husband of Laurie in Ohio, and today I'd like

to talk some more about BILE. Mmmmm, doesn't the word just have a

certain something about it?

First though, I want to tell you all that I am very impressed

with you as a group. What an intense, thoughtful, no punches pulled

bunch you are! Most importantly though, you have helped convince me

that Bariatric surgery is the real deal, and especially the MGB.

It's hard for me to imagine that my wife will feel satisfied after

splitting an appetizer with me and the slowly nibbling on scraps of

my meal. LOL. I probably shouldn't comment more.

I am happy to see your supportive responses to her 1st post.

She worked VERY hard on it, and has again impressed me. It's not

easy being married to a woman who can make such a good argument

though. It simply doesn't matter how right I am, sometimes she can

just out-debate me till I'm dizzy.

Well lets talk about BILE now. If any of you have not read

Laurie's post yesterday and the follow-ups from others, please go

back and find it. My Post is a follow-up. I'm sorry it's long.

When I left our meeting with Dr. Ellison of Ohio State, I was

impressed with him and with his resolve, but the more I thought about

the points he made, the more I realised he is an excellant salesman

who really seems to have finished thinking a long time ago, at least

when talking with people that he does not adore professionally. I

doubt I could have prompted him to to even ponder a thought of my own

without a list of publications in his favorite journals.

Which brings me back to BILE !! He is the professor who made

the point to Laurie's father that the MGB surgery (old loop in his

mind), as he understood it, sounded like what is done to induce

cancer in the esophogus of rats. Of course this freaked him out,

thus leading to the rare and coveted free consultation with the

esteemed surgeon. In our conversation, he revealed that carcinogens

are added after the surgery. When he reiterated that the surgery is

used to induce cancer, I added " when carcinogens are added. " He

ignored it as obviously an irrellavent point.

He said that it takes 5 to 15 years to show up, which sounded

realistic for cancer, but I figured, if you've got reflux that's

destroying your throat, wouldn't you notice it ealier than 5 years?

So I asked him if Bile Reflux occurrs without Acid Reflux. He said

it does. OK, sounds scarey. Only I didn't believe it, so I

researched it. Didn't take long to set my mind at ease. The

following are excerpts from some of the info. I added the links to,

so if you like this type of thing, you can read all the medical

jargon you can stand.

Pathogenesis of Reflux Esophagitis

http://pharminfo.com/meeting/ACG/acg_ehlb11.html

Hydrochloric acid and pepsin appear to be the most important

aggressive factors in the pathogenesis of reflux esophagitis; the

reflux of bile acids playing little or no role in its development.

However, it is defects in the esophageal defenses that are likely the

primary cause for the disorder. The first line of defense is the

physiologic anti-reflux barrier; these mechanisms operate to limit

the frequency of reflux; the second line are the luminal clearance

mechanisms, which operate to decrease the time of contact of

refluxate with the esophageal tissue; and the third line of defense

is epithelial resistance, which protects the tissue from damage

during contact of acid and pepsin with the tissue. Patients with GERD

generally do not have hypersecretion of acid or pepsin and so the

majority of patient have an impairment of one or more of the above

esophageal defense mechanisms.

Bile reflux in benign and malignant Barrett's esophagus and effect of

Nissen fundoplication.

http://www.ssat.com/97ddw/ddw28.htm

Bile reflux occurred primarily during the postprandial and supine

monitoring periods and was usually associated with episodes of acid

reflux.

Managing Acid-Reflux Disorders

http://pharminfo.com/pubs/msb/mangerd.html

The extent of epithelial damage depends on the frequency of reflux

episodes, the length of time the refluxed gastric fluid is in contact

with the mucosa, the contents of the refluxed fluid, and the

intrinsic resistance of the esophageal epithelium to the acid. Acid

and pepsin <../../pia_glos.html> together are more damaging to the

esophageal epithelium than either one alone, and the presence of bile

salts further increases the damage. Relaxation of the lower

esophageal sphincter is more common after meals, and more common

after a high-fat meal (fat delays gastric emptying, and fat in the

duodenum is also a stimulus for relaxation of the lower esophageal

sphincter).

The Relationship Between Acid and Bile Reflux and

Symptoms in Gastro-oesophageal Reflux Disease

http://meds.queensu.ca/gimec/nreflux.htm

Although acid and pepsin are felt to be the prime noxious agents that

mediate reflux esophagitis, conjugated bile acids also have the

potential of exacerbating esophageal mucosal injury. There has been

considerable controversy as to the significance of refluxed bile in

patients with gastroesophageal reflux disease (GERD).

The authors conclude that in patients with gastroesophageal reflux

disease, bile reflux is a very uncommon cause of esophageal symptoms.

Whew !! So what does Laurie's husband think of all this? I

think that IF YOU HAVE IT, reflux is something to be a little more

concerned about for folks who have had the MGB, because there is less

distance between the bile duct and the stomach than with the RY, thus

a higher chance that the combination of bile and acid reflux

together. BUT That is ONLY if you have reflux !! Then if you do get

it, deal with it. You'll have plenty of time before it causes more

than heartburn. Thatis a low risk that I feel is outweighed by the

simplicity of the MGB versus the RY. This was the deciding factor

for me. My last concern is now of lower significance in my mind than

the risks of having ANY surgery.

More significantly, I have less trust in other Bariatric

surgeons, since they seem more interested in reputations among their

brethren than with what's best for the patient.

That's all for now

Dale