1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #300
Pasadena, CA 91105

Category: Alcohol

GERD, Nausea and Vomiting- Don’t ignore it!

April 28, 2015 11:30 am

Gastroesophageal Reflux Disease is a serious matter and should not be left untreated. It is know as heartburn or reflux and if you are experiencing more than twice a week you should be evaluated by a physician to investigate the cause. Listed below are some of the causes and end results of not treating GERD.

Esophagitis – An irritant that can be acid, bile, food and digestive enzymes coming back up the esophagus can cause irritation and swelling in the esophagus. If left untreated, it can damage the lining of the esophagus to the point of erosion and scarring. Bile Reflux may also be a cause of esophagitis and Duodenogastroesphogeal reflux (DGER). Bile Reflux information here.

Esophageal Stricture – Scar tissue can cause the lumen of the esophagus to become smaller and narrow.  This stricture makes it difficult or painful to swallow foods. If a stricture is narrow enough food may become stuck and require intervention for removal and treatment.  This can also put a person at risk for choking. The treatment includes ballon dilation with an endoscope and in cases where it recurs surgery may be required.

Esophageal Ulceration– If GERD is left untreated it can progress to actual ulcerations in the esophagus.  Patients may cough up or vomit blood or see it in their stool as dark tarry or coffee ground type stool.

Gastric Stricture– After weight loss surgery such as sleeve gastrectomy, RNY Gastric Bypass, Duodenal Switch, SADI/Loop,  Adjustable Gastric Banding, or other gastric surgeries a narrowing of the inner opening of the stomach can result from scar tissue forming.  This will require a surgical procedure to rectify.  The symptoms can be food intolerance, full feeling, nausea and/or vomiting. (See pictures below)

Hiatal Hernia– An anatomical weakening or enlargement of the opening of the diaphragm muscle where the esophagus meets the stomach.  This defect can allow a portion of the stomach to slide or roll into the chest cavity. This then causes reflux of gastric juice and content.  Hiatal Hernia’s can also form on weight loss surgical patients.  There are several examples within this blog here.

Breathing Difficulties– The acid aspiration while sleeping can make asthma and other breathing difficulties worst and can cause coughing and other issues.

Dental Issues – The acid, food, digestive enzymes backing up into the esophagus and mouth can cause dental issues such as erosion and tooth decay.  In regards to dental issues after weight loss surgery there are also other vitamin and mineral deficiencies that can cause oral health issues. Dental Issues after WLS here.

Lower Quality of Life– GERD can affect a person’s quality of life.  If you are in discomfort from acid reflux or having food intolerance it can make life difficult.  It can also alter food choices and impact nutrition.

Barrets Esophagus– Pre-cancerous changes in the bottom portion of the esophagus due to long term acid exposure from gastric reflux. Diagnosis requires and endoscopic procedure (EGD) and biopsy.

Esophageal Cancer– There is a significant rise in the western world in esophageal adenocarcinoma. The main risk factors are alcohol use, smoking, untreated GERD, and poor diet.

Reflux and difficulty with swallowing caused by stricture is not normal. These problems are quite frequently encountered as complication of Adjustable gastric banding, with slipped band or a band that is too tight and scarred in placed resulting is belt effect. This results in the esophagus not being able to empty and propel the food down. The end result is significant reflux, with difficulty swallowing, nausea, vomiting etc.  Similar problems are seen with Gastric bypass where the anastomosis between the stomach pouch and the small bowel RNY limb is too narrow. In Gastric Sleeve and Duodenal Switch operations, is the sleeve is made too narrow, or misshaped (hour glass, funnel, cork screw) it will result in the patient having reflux and symptoms of stricture. One specific problem with the new operation of SADI is the concern for  risk of bile reflux, similar to the BillRoth I procedure.

Gastric bypass patient with stricture at the gastro-jejunostomy before and after balloon dilation. Fig A

Screen-Shot-2015-05-13-at-7

After balloon dilation. Fig B

Screen-Shot-2015-04-28-at-9.31

Fig. C : Lap band Patient with stricture where the band as removed at another facility and the scar tissue formed around the GE junction was not taken down. The patient had to be taken back to the operation room after his symptoms persisted even though the band had been removed 3 months prior.

Screen-Shot-2015-04-28-at-9.33

A corkscrew stomach of a Duodenal Switch done at another facility, with the patient presented with persistent reflux, nausea and vomiting for years after surgery.     Fig. D

Screen-Shot-2015-04-28-at-9.35

This is not an inclusive discussion of GERD and the treatment.  Please see your healthcare providers if you are experiencing any symptoms pertaining to GERD or any other health care issue.

Stages of Liver Failure

January 08, 2013 9:38 pm

The liver is probably one of the most forgiving organs when it comes to recovering from an injury. It can take a significant amount of “non structural” injuries and still be able to carry out its function. It is the only solid organ capable of regenerating its volume after a major resection. When a part of the liver is removed, it is within a matter of months that the size of the remaining liver increases to replace the removed portion.

A liver injury can be caused by a number of elements. In regards to weight loss surgery, these elements include alcohol consumption, high doses of Tylenol, excessive weight loss, and the most significant condition called steatohepatitis, also known as “fatty infiltration”. Steatohepatitis causes structural changes in the liver. Over time, the structural changes cause the liver to progress to an end-stage liver disease that requires a transplant. Structural changes to the liver injury are irreversible.

The healthy liver is normally soft and beefy-red with a very smooth and shiny outer layer.

How does steatohepatitis harm the liver? As the fat concentration of the liver increases, the liver loses its sharp edge and becomes distended with small pockets of fat that are visible as yellow satellite lesions.

liver-failure-01
liver-failure-01
liver-failure-03
liver-failure-04
liver-failure-05

The healthy liver is normally soft and beefy-red with a very smooth and shiny outer layer.

How does steatohepatitis harm the liver? As the fat concentration of the liver increases, the liver loses its sharp edge and becomes distended with small pockets of fat that are visible as yellow satellite lesions.

This is gross evidence of steatohepatitis, which is commonly known as fatty infiltration of the liver. The most common cause of this is obesity, in addition to medications such as insulin that are used to treat diabetes. If the underlying cause of steatohepatitis is not addressed, then the liver damage will progressively continue to worsen and eventually be resolved in the structural changes to the liver.

If the physiologic injury to the liver continues unabated, it will develop irreversible cirrhosis. An increasingly continuous insult to the liver will result in sudden liver failure, which will require a liver transplant.

Increased rates of Alcoholism is seen in Gastric bypass patients

December 26, 2011 9:26 pm

This study comes from Dr. Östlund at the Department of Molecular Medicine and Surgery of the Stockholm.  He studied over 12,000 patients that had either a Gastric bypass or gastric restrictive procedure, and looked at their follow up data for an average of 8.9 years. There were more than 122,000 data points matched for a number of variables, including age, gender, and type of procedure. “…Patients undergoing gastric bypass were 2.3 times more likely than those receiving banding procedures to get inpatient treatment for alcohol related diagnosis.” The significance of this study, as pointed out by the authors, is that the data is very reliable because the majority of patients could be followed up over a very long period of time.