RE: EGD & Ulcers -- my take

[Guest guest]

Never having played a doc on TV, I am not at all sure of what I am

about to write, but here's my best shot:

If you were scoped (EGD), the device cannot get beyond your pouch

without disrupting the staples, so if the doc actually saw an ulcer,

it must have been in the pouch or at the stoma (the slit in the pouch

that connects to the intestine. I believe that the latter is called

a " marginal " ulcer.

Many stomach ulcers are caused by the bacteria Helicobacter pylorii.

(I have no idea if H. pylorii is implicated in the formation of

marginal ulcers, however.) The usual treatment for stomach ulcers is

two-pronged: a proton pump inhibitor (PPI: Prilosec, Nexium,

Prevacid, Aciphex, Protonix, others?) to shut off the acid production

and an antibiotic to subdue the H. pylorii (the bacteria thought to

cause the ulcer). Both can reach your lower stomach through the

bloodstream, as has been pointed out. (PPIs take the name because

the " business " end of an acid such as HCl is the hydrogen ion, H+,

and because hydrogen has only a proton in its nucleus, the hydrogen

ion is nothing more than a proton. PPIs are sometimes also called

Hydrogen Pump Inhibitors.)

My understanding is that timed-release or extended-release meds are

activated in the intestine (enteric) and not in the stomach (and,

some, apparently, depend on activation in the liver). So, I don't

think that the problem lies with your unused stomach, but, rather

with a shortened intestine, as in a distal (and, maybe a medial, too)

RNY or a DS. TR/XR meds that are activated in the liver may not be

sensitive to intestinal length (amount bypassed), but I do not have

any idea which meds are which, or if what I wrote about the liver is

really valid; I was just passing along things that I read on other

boards some time ago. Also, I am pretty sure that the acid remains

in the stomach and does not pass into the intestine in a

normally-constructed individual (though the stoma in the pouch can

let some through, possibly leading to marginal ulceration).

If you continue to experience acid reflux up into your esophagus, it

can change the cell types in the esophagus to the point that they,

too, produce acid. The changes can progress to cancer. The

esophagus, when irritated to the point that the tissue separates,

becomes inflamed, and exhibits cell change is called Barrett's

Esophagus. Chronic gastro-esophageal reflux disease (GERD) really

needs to be nipped in the bud so that Barrett's Esophagus does not

develop.

Hope this helps,

Steve (DSer, who, maybe should not be writing about RNY issues)