Bile Reflux - a look at the WHOLE picture - answers to T's quetsions

[Guest guest]

There has been much banter back and forth on all of the MGB lists about bile

reflux. These are my answers to several of the questions posted repeatedly

by .

1. Why does the MGB and no other weight loss surgery, cause bile reflux?

J Clin Gastroenterol 1998 Dec;27(4):335-8 Related Articles, Books,

LinkOut

Gastric pathology in cholecystectomy patients: role of Helicobacter

pylori and bile reflux.

Zullo A, Rinaldi V, Hassan C, Lauria V, Attili AF

Am J Surg 2000 Apr;179(4):298-303 Related Articles, Books, LinkOut

Roux-en-Y jejunal loop and bile reflux.

Collard JM, Romagnoli R

There may not be other weight loss surgeries that regularly cause bile

reflux, but, one of the MOST COMMON OPERATIONS PERFORMED today does.

And..... and you can't see the relevance in this? Cholecystectomy is

considered an extremely common and low risk procedure in the " grand scheme "

of medical care. Although, MGB is certainly NOT considered low risk, why

should the potential risk of bile reflux after MGB be any more pertinent

than bile reflux after cholecystectomy? There are certainly many many more

cholecystectomy than MGB patients out there. Why aren't they protesting?

Why isn't the medical community screaming about this surgery and its

potential long term complications?

Citation number 2 indicates that there are indeed cases where bile reflux is

a result of the RNY as well as the DS operations.

2. Why is bile reflux different and more dangerous than acid reflux?

Hepatogastroenterology 1999 Jan-Feb;46(25):40-7 Related Articles, Books,

LinkOut

Importance of duodeno-gastro-esophageal reflux in the medical outpatient

practice.

Vaezi MF, Richter JE

OK, again, this article does not specifically address Bile reflux after MGB,

but... again, it discusses the big picture. Re-read the conclusions of this

article

CONCLUSIONS: 1) The term " alkaline reflux " is a misnormer (sp) and should no

longer be used in referring to reflux of duodenal contents. 2) Bilitec is

the method of choice in detecting DGER and should always be used

simultaneously with esophageal pH-monitoring for acid reflux. 3) DGER

(duodeno-gastro-esophageal reflux, also termed bile reflux) alone is not

injurious to esophageal mucosa, but can result in significant esophageal

mucosal injury when combined with acid reflux. 4) Therefore, controlling

esophageal exposure to acid reflux by using proton pump inhibitors also

eliminates the potentially damaging effect of DGER.

These conclusions look very " on-point " to the topic at hand. Perspective.

3. Why can the MGB and not other weight loss surgery, cause alkaline-based

ulcers and even cancer?

See answer to question # 1. As you have pointed out repeatedly on this

list, there have been no clinical trials or studies to prove or disprove the

efficacy of the MGB (for weight loss surgery). There have also not been

studies conducted to determine if there is any correlation between MGB and

alkaline-based ulcers and even cancer. There may indeed be signs that this

will be an issue down the road, but... to date, there is no proof of that

fact. Clinical studies are needed. So... in the interim, we are forced to

look at similar operations, similar disease processes, similar situations to

gather our information.

So, the answer to question # 3 is, it is too soon to tell if the MGB has any

direct relevance to the issues of alkaline-based ulcers and cancer. Your

question is a good one, but we will not have the answer for several years.

After reviewing the literature, the correlation of bile reflux (or alkaline

based ulcers, or DGER or whatever else you call it) , and cancer are not a

given. It is still under investigation by many many institutions. I don't

know the answer. Is it relevant to the MGB? We don't really know at this

point.

IN CONCLUSION:

I have not been insulting to anyone in these replies. I have not belittled

ideas and anyone's particular stance on any of these topics. Can we all do

the same? Are we willing to truly LOOK at the literature and really read

it?

I agree that there may well be health concerns down the line for MGB

patients. But, that is no surprise. I was well prepared for those possible

risks by Dr. Rutledge in the patient preparation process. No, the actual

term " bile reflux " or " alkaline reflux " or " alkaline ulcer " was not mentioned

to me specifically. The possibility of ulcers was mentioned as a potential

risk of this surgery. I took this to mean all types of ulcers. Prior to my

surgery, I did find articles indicating that both acid and alkaline ulcers

are areas of concern. Didn't you? It is utterly impossible to disclose

each and every potential complication or outcome as a result of the MGB. I

read the medical literature and made my own educated choice.

Susie Bonds

MGB 1/24/00

283/205

[Guest guest]

good for you!!!

Rick

> There has been much banter back and forth on all of the MGB lists

about bile

> reflux. These are my answers to several of the questions posted

repeatedly

> by .

>

> 1. Why does the MGB and no other weight loss surgery, cause bile

reflux?

>

> J Clin Gastroenterol 1998 Dec;27(4):335-8 Related Articles,

Books,

> LinkOut

> Gastric pathology in cholecystectomy patients: role of

Helicobacter

> pylori and bile reflux.

> Zullo A, Rinaldi V, Hassan C, Lauria V, Attili AF

>

> Am J Surg 2000 Apr;179(4):298-303 Related Articles, Books,

LinkOut

> Roux-en-Y jejunal loop and bile reflux.

> Collard JM, Romagnoli R

>

> There may not be other weight loss surgeries that regularly cause

bile

> reflux, but, one of the MOST COMMON OPERATIONS PERFORMED today does.

> And..... and you can't see the relevance in this? Cholecystectomy

is

> considered an extremely common and low risk procedure in the " grand

scheme "

> of medical care. Although, MGB is certainly NOT considered low

risk, why

> should the potential risk of bile reflux after MGB be any more

pertinent

> than bile reflux after cholecystectomy? There are certainly many

many more

> cholecystectomy than MGB patients out there. Why aren't they

protesting?

> Why isn't the medical community screaming about this surgery and its

> potential long term complications?

>

> Citation number 2 indicates that there are indeed cases where bile

reflux is

> a result of the RNY as well as the DS operations.

>

> 2. Why is bile reflux different and more dangerous than acid

reflux?

>

> Hepatogastroenterology 1999 Jan-Feb;46(25):40-7 Related

Articles, Books,

> LinkOut

> Importance of duodeno-gastro-esophageal reflux in the medical

outpatient

> practice.

> Vaezi MF, Richter JE

>

> OK, again, this article does not specifically address Bile reflux

after MGB,

> but... again, it discusses the big picture. Re-read the

conclusions of this

> article

>

> CONCLUSIONS: 1) The term " alkaline reflux " is a misnormer (sp) and

should no

> longer be used in referring to reflux of duodenal contents. 2)

Bilitec is

> the method of choice in detecting DGER and should always be used

> simultaneously with esophageal pH-monitoring for acid reflux. 3)

DGER

> (duodeno-gastro-esophageal reflux, also termed bile reflux) alone

is not

> injurious to esophageal mucosa, but can result in significant

esophageal

> mucosal injury when combined with acid reflux. 4) Therefore,

controlling

> esophageal exposure to acid reflux by using proton pump inhibitors

also

> eliminates the potentially damaging effect of DGER.

>

> These conclusions look very " on-point " to the topic at hand.

Perspective.

>

> 3. Why can the MGB and not other weight loss surgery, cause

alkaline-based

> ulcers and even cancer?

>

> See answer to question # 1. As you have pointed out repeatedly on

this

> list, there have been no clinical trials or studies to prove or

disprove the

> efficacy of the MGB (for weight loss surgery). There have also not

been

> studies conducted to determine if there is any correlation between

MGB and

> alkaline-based ulcers and even cancer. There may indeed be signs

that this

> will be an issue down the road, but... to date, there is no proof

of that

> fact. Clinical studies are needed. So... in the interim, we are

forced to

> look at similar operations, similar disease processes, similar

situations to

> gather our information.

>

> So, the answer to question # 3 is, it is too soon to tell if the

MGB has any

> direct relevance to the issues of alkaline-based ulcers and

cancer. Your

> question is a good one, but we will not have the answer for several

years.

> After reviewing the literature, the correlation of bile reflux (or

alkaline

> based ulcers, or DGER or whatever else you call it) , and cancer

are not a

> given. It is still under investigation by many many institutions.

I don't

> know the answer. Is it relevant to the MGB? We don't really know

at this

> point.

>

> IN CONCLUSION:

>

> I have not been insulting to anyone in these replies. I have not

belittled

> ideas and anyone's particular stance on any of these topics. Can

we all do

> the same? Are we willing to truly LOOK at the literature and

really read

> it?

>

> I agree that there may well be health concerns down the line for MGB

> patients. But, that is no surprise. I was well prepared for those

possible

> risks by Dr. Rutledge in the patient preparation process. No, the

actual

> term " bile reflux " or " alkaline reflux " or " alkaline ulcer " was not

mentioned

> to me specifically. The possibility of ulcers was mentioned as a

potential

> risk of this surgery. I took this to mean all types of ulcers.

Prior to my

> surgery, I did find articles indicating that both acid and alkaline

ulcers

> are areas of concern. Didn't you? It is utterly impossible to

disclose

> each and every potential complication or outcome as a result of the

MGB. I

> read the medical literature and made my own educated choice.

>

> Susie Bonds

> MGB 1/24/00

> 283/205

>

>

>

>

>