Still vomiting after dilations

[Torressl1234 6]

So I've posted on here before about my issues since surgery. I was vomiting daily after starting the mushy phase. Had my first EGD 4 weeks ago and had a stricture and ulcer. I was dilated from a 12 to a 17. I was good for a few days then began vomiting again. Had my second dilation a week ago went from 17 to 20 which is the highest he can go. Starting yesterday I began vomiting after eating again, continued in to today. So I feel like I'm back at square one. I don't know what's causing the vomiting and if it will ever stop. Has anyone else dealt with this? Especially after being dilated already? I'm just hoping things get better. I've already been in the hospital numerous times for dehydration and electrolyte defecienies. I'm also on extra thiamin and d3 for low Vitamin levels and carafate for ulcer.

[James Marusek 5,244]

You mentioned two problems: strictures and ulcers. So for a moment let us talk about ulcers. According to the internet:

Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

1. So there is a need to avoid NSAIDs like aspirin or Excedrin. Here is a more complete list of other NSAIDs. Ibuprofen, Diclofenac, Naproxen, Meloxicam, Celecoxib, Indomethacin, Ketorolac, Ketoprofen, Nimesulide, Piroxicam, Etoricoxib, Mefenamic acid, Carprofen, Aspirin/paracetamol/caffeine, Etodolac, Loxoprofen, Nabumetone, Flurbiprofen, Salicylic acid, Aceclofenac, Sulindac, Phenylbutazone, Dexketoprofen, Lornoxicam, Tenoxicam, Diflunisal, Diclofenac/Misoprostol, Flunixin, Benzydamine, Valdecoxib, Oxaprozin, Nepafenac, Etofenamate, Ethenzamide, Naproxen sodium, Dexibuprofen, Diclofenac sodium, Bromfenac, Diclofenac potassium, Fenoprofen, Tolfenamic acid, Tolmetin, Tiaprofenic acid, Lumiracoxib, Phenazone, Salsalate, Felbinac, Hydrocodone/ibuprofen, Fenbufen].

2. Then there is a need to take antisecretory therapy with proton-pump inhibitors, and/or sucralfate. Proton pump inhibitors include [Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole, Rabeprazole, Dexlansoprazole, Rabeprazole sodium, Pantoprazole sodium, Esomeprazole magnesium, Omeprazole magnesium, Naproxen/Esomeprazole, Esomeprazole sodium, Omeprazole/Bicarbonate ion] and/or sucralfate [Carafate] antacid. You mentioned that you are taking Carafate. As a routine practice, my surgeon prescribed Omeprazole [over the counter Prilosec] to me for the first year to allow my stomach to heal.

3. And finally have yourself tested for H pylori infection. Others on this website have discovered they had this infection and didn't even know it and it was the cause of all their problems.

I am not a doctor so take everything that I said with a grain of salt.

[shedo82773 1,236]

Hi Torressl1234,

I am 3 years out from my RNY. I can totally relate. I had 5 Endoscopes with 4 Dialations. It started almost right away. When I went back for my checkup I said that it felt like my food sat on top of my pouch and would eventually would go down. My PA said maybe we should do a Endoscope to check it out. I told him no because I really thought it was me finding my fullness. In NOV 2013 I couldn't hold down even Water. I had Strictures again DEC, again Jan 2014, July 2014 with my last endo and Dialation was Jan 2015. Thankfully I have not had any more problems. BTW I did have an ulcer also and he removed some staples during one of the ENDO's. I DID NOT over eat, drink when I ate or cheated in any way. Strictures are basically like scar tissue and my DR said they just don't know who will have a problem. So don't feel like you did something wrong!! My finally dialation they used a size 18 balloon, My PCP did start me on a medication that healed my Ulcer. It was called DEXALENT. My Surgeon did put me on CARAFATE but it just didn't do the trick. So you are not alone with this. It happens. If you are vomiting and can't hold down fluids, I would call my Dr. You just may need another dialations. I'm sorry you are going thru this. Take care and get better soon.

[teedsg 253]

@@Torressl1234, sorry to hear you are going through this, but go back to your surgeon, I pray that you get better soon.