Re: Bile reflux question for Dr. R and post ops

[Guest guest]

The actigall we take is for bile reflux.

-Ginny I.

> Ok, Dr. R said that the MGB cures acid reflux.. GREAT!! I would

love

to have

> that problem gone!! ;<)

>

> But, if the MGB causes bile reflux, like Dr. R said.. what treats

it?

> What about the long term side effects from the bile reflux?

>

> What about alkaline-based ulcers I have been reading about?

> I haven't been able to find what, if anything they are treated

by...

does

> anyone know?

>

> No, I am NOT part of the Militia with !! LOL

>

> I am just trying to sort things out here for myself, and others I

have talked

> to about this privately. After all we are suppose to find out all

the

> possible risk of this surgery.. right. I know with so many post

ops

out

> there.. some one should have my answers :<)

>

> Dr. R>> do you have any answers?

>

> Thanks!!!

> Cindy

[Guest guest]

In a message dated 10/3/00 9:44:34 PM Central Daylight Time,

Dr_Rutledge@... writes:

<< No, the Mini-Gastric Bypass does not cause cancer >>

WHat kind of follow up research do you do on patients and how long have u

been doing this procedure????

[Guest guest]

Hi,

Please see

http://clos.net/grumpy/grumpy.htm

http://clos.net/billroth_ii_today.htm

http://clos.net/old-loop.htm

http://clos.net/billroth2/billroth_ii_ca.htm

http://clos.net/aotd/05-00/aotd0531.htm

http://clos.net/billroth2/cause-g-ca01.htm

http://clos.net/billroth2/cause-g-ca02.htm

http://clos.net/billroth2/b2-ca01.htm

http://clos.net/billroth2/b2-ca02.htm

http://clos.net/billroth2/b2-ca03.htm

http://clos.net/billroth_cancer_surgeons.htm

http://clos.net/billroth2/ulcer-ca01.htm

http://clos.net/billroth2/ulcer-ca02.htm

No, the Mini-Gastric Bypass does not cause cancer.

A concern raised by some Doctors, is the potential association of the

Billroth II (BII) type connection used in the Mini-Gastric Bypass with

stomach (gastric) cancer.

There are some medical studies that seem to raise concerns about the

relation between the Billroth II type connection and gastric cancer. A

careful review shows that this is not a reasonable concern.

Many of the papers showing an association between Billroth II and gastric

cancer are out of date. A good example of a well-done study looking at this

question was published in the New England Journal by Schafer et. al. In this

study the Mayo Clinic studied residents of Minnesota, who had surgery for

ulcers between 1935 to 1959. These patients were followed for over 5,635

person-years. They found gastric cancer in only two of the patients in the

surgical group, as compared with an expected rate of 3 people.

That is, they found that the rate of gastric cancer in the surgery patients

was actually lower than that seen in unoperated patients. Many other studies

of Billroth II patients have found no evidence of an increased incidence of

gastric cancer.

In a recent study by Bassily the records of 569 patients who had a partial

gastrectomy for ulcer disease were analyzed. Five hundred and seven patients

(83.5%) had a Billroth II. They showed that " the risk of gastric cancer was

not increased after Billroth II partial gastrectomy. "

In a study from Finland the risk of gastric cancer after gastric surgery for

ulcer was reported. Six of the 285 patients developed gastric cancer after

the operation. The risk of contracting gastric cancer in the rest of the

population (individuals who had no operation) of equal size and age during a

similar follow-up period was 8 cases. That is to say, the operated patients

had a lower risk of gastric cancer than the nonoperated patients. This

study, as well as many others, shows that the risk of gastric cancer does

not significantly increase after partial gastrectomy for benign peptic

ulcer.

It is true that there are some studies that appear to show an increased risk

of gastric stump cancer as compared to the general population. But these

studies are seriously flawed.

All of the studies that show slight increases in the rate of gastric cancer

following Billroth II include patients that have had the surgery for ulcer

disease. The problem with this kind of study design is the fact that gastric

ulcer is associated with an increased risk of gastric cancer.

For example, in a study by Molloy and Sonnenberg the association between

ulcer and gastric cancer was demonstrated in patients from the US Department

of Veterans Affairs. 3,078 subjects with gastric cancer were compared with a

89,082 people without gastric cancer. This study showed that gastric ulcer

patients had an increased rate of gastric cancer (relative risk 1.53, note

that this increased risk is similar in magnitude to the increased risk

reported in the studies showing an increased risk of gastric cancer in

Billroth II surgical patients.) Many other studies confirm these findings

that ulcer patients have an increased risk of gastric cancer.

In a study by Hansson published in the New England Journal of Medicine the

risk of stomach cancer in 57,936 patients was analyzed. The rate of gastric

cancer among patients with gastric ulcers was increased 1.8 times. Again,

this value is very similar to that reported for the increase seen in some

studies of post-gastrectomy patients. They concluded that gastric ulcer

disease and gastric cancer have causative factors in common.

Thus the studies that find small increased rates of gastric cancer in post

gastrectomy patients may simply be identifying gastric ulcer patients that

are prone to develop gastric cancer regardless of any surgery they may have

had.

It is also important to look at the actual size of the reported increased

risk of stomach cancer in the series that appear to find an increased risk

of stomach cancer in post gastrectomy patients. In other words, how much of

an increased risk are we talking about and how does that compare to other

factors involved in the development of gastric cancer. As described above

the majority of studies find no increased risk of gastric cancer in Billroth

II patients, but in the studies that do find an increase in risk, how much

of an increase is seen and how does this compare to other factors involved

in the development of gastric cancer?

Analysis of these issues can put these studies reporting an increased risk

of gastric cancer into proper perspective.

Hundreds of articles have looked at factors that affect the development of

gastric cancer. These studies of stomach cancer indicate that salted,

smoked, pickled, and preserved foods (rich in salt, nitrite, and preformed

N-nitroso compounds) are associated with an increased risk of gastric

cancer. There is good evidence that the high eating fresh fruit and raw

vegetables and a high intake of antioxidants are associated with reduced

risks of gastric cancer.

Now with all of these factors know to affect the risk of gastric cancer,

where is post-gastrectomy positioned as a risk factor? Extensive research

shows that gastric cancer has an environmental cause, of which diet appears

to be the most important component. Studies show that there is an

approximately a threefold increased risk of gastric cancer for frequent

consumption of fresh and processed meats (relative risk 3.1 and 3.2).

Gastric cancer risk rises with increasing intake of smoked and pickled foods

(relative risk 3.7.) All of these factors that increase the risk of gastric

cancer are as much as twice as high as that seen with the studies showing an

effect of gastrectomy on gastric cancer risk. Many studies also show a

decreasing risk of stomach cancer with increasing frequency of vegetable

consumption. Increased intake of citrus fruits (risk 0.47) and raw-green

vegetables (risk 0.56) appear to be protective. Consumption of salty snacks

more than twice per month has been associated with an 80 percent increased

risk. These findings are consistent with many studies around the world that

indicate important roles for salt, processed meats, and vegetable

consumption in the risk of gastric cancer.

There are dozens more articles like these but we can summarize these

findings as follows: Billroth II post gastrectomy patients are at little

or no increased risk of gastric cancer.

If either they or their physicians are concerned about gastric cancer

it appears that very simple dietary modifications (i.e. avoiding processed

meats, smoked and pickled foods while increasing one's intake of fresh

fruits and vegetables, with or without supplementation with additional

antioxidant vitamins) can have a much greater impact on the patient's

lifetime risk of gastric cancer than that of the gastrectomy.

Another way to put this is to say that a regular diet of bologna

sandwiches appears to be of greater risk to a patient for the development of

gastric cancer than the Billroth II.

Helicobacter Pylori Evidence of an association between Helicobacter pylori

infection and gastric cancer risk has been shown by most studies. The

increased risk is two- to threefold increase in risk over normal. Studies

clearly show that H Pylori not gastrectomy appears to be the risk factor

associated with gastric cancer and physicians who feel this is of concern

can provide treatment to patients to eradicate H. Pylori.

It may also be of value to point out that thousands of general surgeons

routinely perform the Billroth II anastomoses on a daily basis. Tens of

thousands of patients undergo Billroth II type gastrojejunostomy on a yearly

basis and there is no ground swell effort being generated against the risk

of the Billroth II type anastomoses.

RR

Rutledge, M.D., F.A.C.S.

The Center for Laparoscopic Obesity Surgery

4301 Ben lin Blvd.

Durham, N.C. 27704

Telephone #:

Fax #:

Email: DrR@...

************************************************

Please Visit our Web site: http://clos.net

************************************************

Please join the

Mini-Gastric Bypass Community at

http://www.egroups.com/group/MiniGastricBypass

Get the

Mini-Gastric Bypass

Patient Education Manual

( http://www.clos.net/get_patient_manual.htm )

Bile reflux question for Dr. R and post ops

> Ok, Dr. R said that the MGB cures acid reflux.. GREAT!! I would love to

have

> that problem gone!! ;<)

>

> But, if the MGB causes bile reflux, like Dr. R said.. what treats it?

> What about the long term side effects from the bile reflux?

>

> What about alkaline-based ulcers I have been reading about?

> I haven't been able to find what, if anything they are treated by... does

> anyone know?

>

> No, I am NOT part of the Militia with !! LOL

>

> I am just trying to sort things out here for myself, and others I have

talked

> to about this privately. After all we are suppose to find out all the

> possible risk of this surgery.. right. I know with so many post ops out

> there.. some one should have my answers :<)

>

> Dr. R>> do you have any answers?

>

> Thanks!!!

> Cindy

>

>

[Guest guest]

Thank you Dr. R. We have been awaiting your response.

Bud & Dinah Boatwright

> Hi,

>

> Please see

>

> http://clos.net/grumpy/grumpy.htm

>

> http://clos.net/billroth_ii_today.htm

>

> http://clos.net/old-loop.htm

>

> http://clos.net/billroth2/billroth_ii_ca.htm

>

> http://clos.net/aotd/05-00/aotd0531.htm

>

> http://clos.net/billroth2/cause-g-ca01.htm

>

> http://clos.net/billroth2/cause-g-ca02.htm

>

> http://clos.net/billroth2/b2-ca01.htm

>

> http://clos.net/billroth2/b2-ca02.htm

>

> http://clos.net/billroth2/b2-ca03.htm

>

> http://clos.net/billroth_cancer_surgeons.htm

>

> http://clos.net/billroth2/ulcer-ca01.htm

>

> http://clos.net/billroth2/ulcer-ca02.htm

>

>

> No, the Mini-Gastric Bypass does not cause cancer.

>

> A concern raised by some Doctors, is the potential association of

the

> Billroth II (BII) type connection used in the Mini-Gastric Bypass

with

> stomach (gastric) cancer.

>

> There are some medical studies that seem to raise concerns about the

> relation between the Billroth II type connection and gastric

cancer. A

> careful review shows that this is not a reasonable concern.

>

> Many of the papers showing an association between Billroth II and

gastric

> cancer are out of date. A good example of a well-done study looking

at this

> question was published in the New England Journal by Schafer et.

al. In this

> study the Mayo Clinic studied residents of Minnesota, who had

surgery for

> ulcers between 1935 to 1959. These patients were followed for over

5,635

> person-years. They found gastric cancer in only two of the patients

in the

> surgical group, as compared with an expected rate of 3 people.

>

> That is, they found that the rate of gastric cancer in the surgery

patients

> was actually lower than that seen in unoperated patients. Many

other studies

> of Billroth II patients have found no evidence of an increased

incidence of

> gastric cancer.

>

> In a recent study by Bassily the records of 569 patients who had a

partial

> gastrectomy for ulcer disease were analyzed. Five hundred and seven

patients

> (83.5%) had a Billroth II. They showed that " the risk of gastric

cancer was

> not increased after Billroth II partial gastrectomy. "

>

> In a study from Finland the risk of gastric cancer after gastric

surgery for

> ulcer was reported. Six of the 285 patients developed gastric

cancer after

> the operation. The risk of contracting gastric cancer in the rest

of the

> population (individuals who had no operation) of equal size and age

during a

> similar follow-up period was 8 cases. That is to say, the operated

patients

> had a lower risk of gastric cancer than the nonoperated patients.

This

> study, as well as many others, shows that the risk of gastric

cancer does

> not significantly increase after partial gastrectomy for benign

peptic

> ulcer.

>

> It is true that there are some studies that appear to show an

increased risk

> of gastric stump cancer as compared to the general population. But

these

> studies are seriously flawed.

>

> All of the studies that show slight increases in the rate of

gastric cancer

> following Billroth II include patients that have had the surgery

for ulcer

> disease. The problem with this kind of study design is the fact

that gastric

> ulcer is associated with an increased risk of gastric cancer.

>

> For example, in a study by Molloy and Sonnenberg the association

between

> ulcer and gastric cancer was demonstrated in patients from the US

Department

> of Veterans Affairs. 3,078 subjects with gastric cancer were

compared with a

> 89,082 people without gastric cancer. This study showed that

gastric ulcer

> patients had an increased rate of gastric cancer (relative risk

1.53, note

> that this increased risk is similar in magnitude to the increased

risk

> reported in the studies showing an increased risk of gastric cancer

in

> Billroth II surgical patients.) Many other studies confirm these

findings

> that ulcer patients have an increased risk of gastric cancer.

>

> In a study by Hansson published in the New England Journal of

Medicine the

> risk of stomach cancer in 57,936 patients was analyzed. The rate of

gastric

> cancer among patients with gastric ulcers was increased 1.8 times.

Again,

> this value is very similar to that reported for the increase seen

in some

> studies of post-gastrectomy patients. They concluded that gastric

ulcer

> disease and gastric cancer have causative factors in common.

>

> Thus the studies that find small increased rates of gastric cancer

in post

> gastrectomy patients may simply be identifying gastric ulcer

patients that

> are prone to develop gastric cancer regardless of any surgery they

may have

> had.

>

> It is also important to look at the actual size of the reported

increased

> risk of stomach cancer in the series that appear to find an

increased risk

> of stomach cancer in post gastrectomy patients. In other words, how

much of

> an increased risk are we talking about and how does that compare to

other

> factors involved in the development of gastric cancer. As described

above

> the majority of studies find no increased risk of gastric cancer in

Billroth

> II patients, but in the studies that do find an increase in risk,

how much

> of an increase is seen and how does this compare to other factors

involved

> in the development of gastric cancer?

>

> Analysis of these issues can put these studies reporting an

increased risk

> of gastric cancer into proper perspective.

>

> Hundreds of articles have looked at factors that affect the

development of

> gastric cancer. These studies of stomach cancer indicate that

salted,

> smoked, pickled, and preserved foods (rich in salt, nitrite, and

preformed

> N-nitroso compounds) are associated with an increased risk of

gastric

> cancer. There is good evidence that the high eating fresh fruit and

raw

> vegetables and a high intake of antioxidants are associated with

reduced

> risks of gastric cancer.

>

> Now with all of these factors know to affect the risk of gastric

cancer,

> where is post-gastrectomy positioned as a risk factor? Extensive

research

> shows that gastric cancer has an environmental cause, of which diet

appears

> to be the most important component. Studies show that there is an

> approximately a threefold increased risk of gastric cancer for

frequent

> consumption of fresh and processed meats (relative risk 3.1 and

3.2).

> Gastric cancer risk rises with increasing intake of smoked and

pickled foods

> (relative risk 3.7.) All of these factors that increase the risk of

gastric

> cancer are as much as twice as high as that seen with the studies

showing an

> effect of gastrectomy on gastric cancer risk. Many studies also

show a

> decreasing risk of stomach cancer with increasing frequency of

vegetable

> consumption. Increased intake of citrus fruits (risk 0.47) and raw-

green

> vegetables (risk 0.56) appear to be protective. Consumption of

salty snacks

> more than twice per month has been associated with an 80 percent

increased

> risk. These findings are consistent with many studies around the

world that

> indicate important roles for salt, processed meats, and vegetable

> consumption in the risk of gastric cancer.

>

> There are dozens more articles like these but we can summarize these

> findings as follows: Billroth II post gastrectomy patients are at

little

> or no increased risk of gastric cancer.

> If either they or their physicians are concerned about gastric

cancer

> it appears that very simple dietary modifications (i.e. avoiding

processed

> meats, smoked and pickled foods while increasing one's intake of

fresh

> fruits and vegetables, with or without supplementation with

additional

> antioxidant vitamins) can have a much greater impact on the

patient's

> lifetime risk of gastric cancer than that of the gastrectomy.

> Another way to put this is to say that a regular diet of

bologna

> sandwiches appears to be of greater risk to a patient for the

development of

> gastric cancer than the Billroth II.

>

>

> Helicobacter Pylori Evidence of an association between Helicobacter

pylori

> infection and gastric cancer risk has been shown by most studies.

The

> increased risk is two- to threefold increase in risk over normal.

Studies

> clearly show that H Pylori not gastrectomy appears to be the risk

factor

> associated with gastric cancer and physicians who feel this is of

concern

> can provide treatment to patients to eradicate H. Pylori.

>

> It may also be of value to point out that thousands of general

surgeons

> routinely perform the Billroth II anastomoses on a daily basis.

Tens of

> thousands of patients undergo Billroth II type gastrojejunostomy on

a yearly

> basis and there is no ground swell effort being generated against

the risk

> of the Billroth II type anastomoses.

>

> RR

>

> Rutledge, M.D., F.A.C.S.

> The Center for Laparoscopic Obesity Surgery

> 4301 Ben lin Blvd.

> Durham, N.C. 27704

> Telephone #:

> Fax #:

> Email: DrR@c...

>

> ************************************************

> Please Visit our Web site: http://clos.net

> ************************************************

> Please join the

> Mini-Gastric Bypass Community at

> http://www.egroups.com/group/MiniGastricBypass

>

> Get the

> Mini-Gastric Bypass

> Patient Education Manual

> ( http://www.clos.net/get_patient_manual.htm )

> Bile reflux question for Dr. R and

post ops

>

>

> > Ok, Dr. R said that the MGB cures acid reflux.. GREAT!! I would

love to

> have

> > that problem gone!! ;<)

> >

> > But, if the MGB causes bile reflux, like Dr. R said.. what treats

it?

> > What about the long term side effects from the bile reflux?

> >

> > What about alkaline-based ulcers I have been reading about?

> > I haven't been able to find what, if anything they are treated

by... does

> > anyone know?

> >

> > No, I am NOT part of the Militia with !! LOL

> >

> > I am just trying to sort things out here for myself, and others I

have

> talked

> > to about this privately. After all we are suppose to find out all

the

> > possible risk of this surgery.. right. I know with so many post

ops out

> > there.. some one should have my answers :<)

> >

> > Dr. R>> do you have any answers?

> >

> > Thanks!!!

> > Cindy

> >

> >

[Guest guest]

> In a message dated 10/3/00 9:44:34 PM Central Daylight Time,

> Dr_Rutledge@c... writes:

>

> << No, the Mini-Gastric Bypass does not cause cancer >>

> WHat kind of follow up research do you do on patients and how long

have u

> been doing this procedure????

The answer to all of your questions can be found on Dr R's web site.

www.clos.net

Have you ever visited it? I'm sure you will find it very informative.

[Guest guest]

Thanks -- this is good damage control. Kaufmann