From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: sci.med
Subject: Re: Radical Gastrectomy Help
Date: 10 Mar 2004 18:35:57 -0600
Message-ID: <404fb30d$0$70253$45beb828@newscene.com>

<serabg@yahoo.com> wrote in message
news:5ab16b19.0403101341.20a23f2@posting.google.com...
> Hello everyone,
>
> I am seeking advice regarding bile reflux. My mother had a radical
> gastrectomy about 7 years ago, at first she had a difficult time
> holding down food but had been doing alot better.
>
> The problem right now is that she sometimes feels a burning sensation
> along her asophagus, her doctor says its Bile, and she takes Carafate
> to keep it under control. It helps but still does not totally keep the
> bile under control, often at night she says she feels the same burning
> sensation come back.
>
> I am worried that this "burning" might be wearing away her asophagus,
> and I am wondering if anybody has any advice. I've asked the doc but
> he has no further suggestion beyond Carafate, does anybody have any
> ideas?
>
> I've been trying to find resources on the net for people who have had
> radical gastrectomies and their experiences, but so far have come up
> empty.
>
> Thank you for listening, and best wishes to all those other folks out
> there who are sick or suffering.


It would be important to know how her esophagus was re-connected to the rest
of her intestinal tract after the stomach was removed. Normally it would be
done in a configuration called "roux-en-y". This routes all of the bile and
pancreatic enzymes well downstream from the esophagus. Sometimes, the
esophagus may be reconnected to the small intestine as just an in-continuity
loop. This is a bad way to do it because all of the bile etc must flow right
by the esophagus.

If she is having a lot of bile reflux, then the esophagus was either
reattached via an in-continuity loop, or the surgeon didn't make a long
enough intestinal limb for the roux-en-y. In either case, re-operation would
be the only way to stop the bile reflux.

Bile reflux is indeed a problem in that is does severely irritate the lower
esophagus. It can acutely increase the risk of severe esophagitis, and
chronically increase the risk of esophageal cancer. She should re-visit her
surgeon. She needs an upper GI endoscopy, and she needs to understand how
the esophagus was re-connected. Get a copy of her operative report and visit
another surgeon for a second opinion if necessary. If re-operation is
required, as it probably is, some surgeons can do that laparoscopically.

HMc