Bile acid diarrhea problems. Should I get sleeve or RnY?

[ShellyM13 0]

Hi y’all! I’m Shelly. I’m in Arkansas and I’m in the process of going through my 6 month of diet and exercise counseling that my insurance is requiring. I still have 4 months to go. I have a question though. I’m signed up to get the RnY but I have had pretty bad bile acid diarrhea for Years. So much so that I had developed rectal fissures that required surgery! I was talking to my gastroenterologist surgeon today at my last appointment and told him I was going to get the gastric bypass and would it Help with my bile acid problem. He is very Leary about me having the surgery since it is taking a part of my intestine that helps with the acid. He’s afraid it’ll make my problems a lot worse since there would be less intestines for the bile to travel and it would cause more diarrhea. Has anyone had any experience with bile acid diarrhea Before surgery!? Thanks

[catwoman7 11,248]

they don't really bypass much of the intestine with RNY (not like they do with the DS), but then, I don't really know whether or not - or how much - of the intestine that they re-route is related to bile acids. I'd ask your bariatric surgeon, too. I've been hanging out on this and other boards for the last six or seven years, and this is the first time this has come up, believe it or not...

P.S. if it would be an issue, then sleeve would probably still be an option, since that surgery is all on your stomach - they don't touch your intestines.

Edited June 10, 2021 by catwoman7

[ShellyM13 0]

My gastroenterologist surgeon said that the sleeve might be a better option. Thanks so much for responding!!

[RickM 1,753]

This is something of a tricky situation, and the real experts would be your surgeon and your gastro getting their heads together on it. I'm not that familiar with your situation, but implicitly, there is some imbalance between your stomach acid and bile, and how they neutralize each other. Normally, your stomach acid is neutralized in your duodenum, (the part of your intestines immediately downstream of your stomach where the bile ducts enter the picture.) That will remain the case with the sleeve, as that part of the anatomy remains unchanged. Speculatively, it might improve things as with the sleeve we have some tendency to over produce acid (the stomach volume is cut down much more than the acid producing potential of the stomach) so this might better neutralize the bile secretions.

With the RNY, the stomach is divided into two, with the small pouch that produces some acid connecting downstream of the duodenum, and the larger blind remnant stomach remaining in its natural place just upstream of the duodenum, wiht its acid still there to neutralize the bile secretions. The route from the duodenum down to the rectum will be a couple of feet or so shorter as the roux limb is brought up to the stomach pouch, and what acid secretions that you get from the pouch will be introduced a bit farther down.

Another consideration to look into (ask your doctors) is the prospect of bile reflux - the opposite of what you are having, where it goes back upstream into the stomach and above. The RNY, and other allied procedures such as the mini-bypass and SIPS/SADI, have some predisposition toward bile reflux. This isn't usually a problem with the way RNYs are constructed these days, but it may be a consideration if you are starting out with an imbalance (again, this is amateur speculation, but talk to your docs about it.)

[ShellyM13 0]

Wow you know a Lot! Thanks so much! I have put in an email to my Bariatric surgeon to see what they say. I really appreciate you taking the time to respond.