So I met with surgeon today for last appointment prior to insurance submission. I asked all my questions and we had a good discussion. He said of all the complications the real “thorn in their side” was ulcers. Even as an entire practice rate of ulcers is about 15-20% lifetime. And lifetime use of PPI or at least 4-5 years dropping to the lesser Pepcid etc type drugs forever. I am astonished by this!!! Is this true? Is there a reason it’s so high? I mean my mother in law had open RNY about 25 years ago and is not a model patient. She eats ibuprofen etc like crazy, tons of soda and the like and never an ulcer. Any opinions, suggestions on diet or anything to prevent? I’m not a smoker or alcohol user now but even without that’s the rate. Or, like doc said it is a surgery that creates ulcers based on plumbing.
This has me really second guessing even more

5 hours ago, mrsjo said:

Is this true?

No of course it's not. The rate of ulceration over any period post RNY is 4.6% but avoiding NSAIDs and smoking will make your average much lower still.

https://pubmed.ncbi.nlm.nih.gov/24234733/

5 hours ago, mrsjo said:

I’m not a smoker or alcohol user

Greece smoking rate, 39%. Life expectancy, 82.

USA smoking rate, 14%. Life expectancy, 78.

Put down the onion rings!

Just now, Pollito said:

USA smoking rate, 14%. Life expectancy, 78

While having ermergerd sodium warnings on things (you know those kidneys you have? Yeah, guess what they do ... ), but not 'oh and it has 1,800 calories per portion' flashing red warnings.

Yeah, half the bariatric surgery websites I read in the US warn against fast food due to high sodium. Show me the evidence. I also want evidence on saturated fat and cholesterol while you're at it. Nonsense. I understand there's correlation, no ****, but when I was going Keto, often as not I used to rip the bun off two long chilli cheese burgers from Burger King (Swiss thing, awesome) and I was skinny and my blood work was epic. Oh and caffeine too. There's so much nonsense out there and half of it is from people whose names end in MD.

they can happen, yes, but if the risks were that high, we'd see a lot more postings about it on bariatric forums. I've been on this and other forums for over seven years, and we do see an occasional post, but not that many. I think that stat he gave you sounds a bit suspicious. (Actually, I just now did a quick google search. Here is a peer reviewed study that also says 4.6% - same as what someone above said) https://pubmed.ncbi.nlm.nih.gov/24234733/

also - PPI's. It's common for surgeons to have their patients on them for 3-6 months after surgery while they're healing. But after that? No. Unless people have GERD or something, which is rare with RNY.

avoiding ulcers is the reason they've told RNY patients for years to avoid taking NSAIDS - and recently I've heard of more sleeve patients being told to avoid NSAIDs as well.

honestly, I'm not sure where he's getting these numbers.

On 03/17/2022 at 07:28, catwoman7 said:

they can happen, yes, but if the risks were that high, we'd see a lot more postings about it on bariatric forums. I've been on this and other forums for over seven years, and we do see an occasional post, but not that many. I think that stat he gave you sounds a bit suspicious. (Actually, I just now did a quick google search. Here is a peer reviewed study that also says 4.6% - same as what someone above said) https://pubmed.ncbi.nlm.nih.gov/24234733/

also - PPI's. It's common for surgeons to have their patients on them for 3-6 months after surgery while they're healing. But after that? No. Unless people have GERD or something, which is rare with RNY.

avoiding ulcers is the reason they've told RNY patients for years to avoid taking NSAIDS - and recently I've heard of more sleeve patients being told to avoid NSAIDs as well.

honestly, I'm not sure where he's getting these numbers.

I too, wondered where those numbers came from. Then I thought, is there something his group does specifically with surgical technique that causes that? Then of course my mind just wonders…..
As I said I know several people, again that’s a small sample size, but even they do the things that are not supposed to be done and never an ulcer. Just wondering what experiences here have been. Didn’t seem like I’d seen it mentioned in that shockingly of a statistic

4 hours ago, mrsjo said:

I too, wondered where those numbers came from. Then I thought, is there something his group does specifically with surgical technique that causes that? Then of course my mind just wonders…..
As I said I know several people, again that’s a small sample size, but even they do the things that are not supposed to be done and never an ulcer. Just wondering what experiences here have been. Didn’t seem like I’d seen it mentioned in that shockingly of a statistic

I would ask your surgeon why his rate of ulcers is much higher than the average. That would be a red flag to me.

I know this post is older but, yes, they are starting to discover marginal ulcer rates as high as 25% (although the rates vary from study to study. You also have to understand that includes small ulcers that heal or show no symptoms, not the big, problem causing ones that are a cause for revision surgery).

The reason is because of the surgery itself: they're connecting the jejunum up to your stomach. The jejunum usually connects to the bottom of the duodenum. The duodenum releases bicarbonate to reduce acid intensity and by the time the chyme (mushed up food content from your stomach) reaches the bottom of the duodenum, acidity is fairly low. That sort of acidity the jejunum can handle.

Now that the jejunum is connected directly to the stomach, the acidity of the food that travels down it is much higher. The jejunum toughens up a bit over time and it has its own defences, but not to the level of the duodenum. So the chances of ulceration can be (not with everyone, but sometimes) much higher.

This is why they won't do this operation for people who smoke or take NSAIDs. In an operation that increases ulcer risk, operating on people who are guaranteed to get an ulcer already is contraindicated.

My advice would be to never smoke, take NSAIDs, and try and take something like zinc carnosine or l-glutamine to help support the tissue integrity of your jejunum to reduce the chances of ulcers forming.

Edited July 20Jul 20 by ged12345