Reflux

[Writergirl 230]

Hi! (Sorry for this long post.) I'm nearing the end of my pre-op requirements, and as I posted in another topic, I found out I have Barrett's Esophagus, which is caused by acid reflux. I've now consulted with the bariatric surgeon and the gastroenterologist.

--The bariatric surgeon strongly recommends I have a gastric bypass instead of the sleeve, but admits he's never had a sleeve patient with Barrett's.

--The gastro says I should have the sleeve because he has had so many patients with severe complications from the bypass.

--The bariatric surgeon says the sleeve may cause a lot of reflux and I'll have to eventually have a bypass to fix it.

--The gastro says the reflux shouldn't really effect the Barrett's.

So, I'm confused. I told them both that, to me, the bypass feels like mutilation. I swore I'd never do it, and it's actually making me consider trying a low-carb diet instead (something I've never been successful at sticking to). Anyway, I'm wondering how many people have severe issues with reflux, to the point where they wish they hadn't sleeved. If you've had reflux, did it go away with medication or weight loss? I've just started protonix. Any thoughts on this issue that I haven't mentioned? On the one hand, I don't want a bypass. On the other hand, I don't want to be physically miserable for the rest of my life. Thanks for reading this long post. Mary Lynne

[Tiffykins 672]

There is a lady on obesityhelp.com who is in your same position, but I can not for the life of me remember her screen name. I'll see if I can't dig up her most recent post as she just posted a week or so ago, and I'll message you her topic over there. She physically can not have RNY, but has Barrett's. The concern with Barrett's and VSG is that in the event the Barrett's were to progress, there isn't a lot of tissue left to reconstruct your esophagus. HOWEVER, if your reflux can be controlled with meds, and you do enough research that you feel comfortable having the sleeve, then I would choose the sleeve. I would not by any means have RNY even if that meant I had to stay fat.

RNY would more than likely cure your reflux, but then again, it might not. This is just what I would do if I were in your situation, I would consult an oncologist who specializes in stomach/esophageal/GI cancers and get their opinion. You've already got Barrett's, will RNY effect the absorption of vital medications in the event the Barrett's progresses???

[Escape_Pod 358]

I had bad reflux pre-op, and despite finding a large hiatal hernia that was the likely cause, one surgeon (also the gastro who did my upper endoscopy) strongly advised me to have RNY. Another felt I'd be fine with the sleeve, but only because they found no Barrett's esophagus.

It was a tough decision for me, but I was definitely going to proceed with surgery, even if it meant RNY. I know a lot of people are turned off by the regain stats for RNY, but my two cents is, we'll see more of that with the sleeve as it becomes more common and we have more people 6+ years out. I don't have a cite to it handy, but there's a discussion on one of the other forums about a study that found that for 85% of those who regain (even with RNY), the causes are noncompliance with the post-op diet requirements (Protein first, don't drink with meals, etc.) These are things in your control!

Yes, there are down sides to RNY, and for people with certain medical issues, RNY may be a really bad option. But Barrett's esophagus can send you down the road to esophageal cancer, even if you have no post-op acid issues or have it under control. (My husband has some Barrett's, and he has an upper GI every few years to keep an eye on it). I lost my mom to esophageal cancer last year, she didn't even know she had it until it was far too late and it had spread to her stomach and liver. Less than 8 weeks after diagnosis she was gone. So, admittedly, this is something I'm pretty sensitive about. I'm not saying this will happen to you if you have the sleeve, but it's a factor to weigh, and to weigh seriously. Because of the design of the sleeve, it can really increase the pressure tending to push acid back up into your esophagus. If you've already got tissue damage, you're at high risk for problems post-op. Bypass would be a much safer option for you. Does that mean it's your best choice? Not necessarily, but it's something only you and your doctor can know based on your personal circumstances.

I'd recommend talking to the doctor more about your concerns about bypass and why you don't want it. Then you can make the best possible educated decision.