MGB bile reflux gastritis and marginal ulcer (2)

1. Dr. Robert Rutledge
Title:
Bile, Reflux, Gastritis And
Marginal Ulcer Following Billroth
II;
Management of Dyspepsia After
Mini-Gastric Bypass

2. BILE, REFLUX, GASTRITIS AND
MARGINAL ULCER FOLLOWING
BILLROTH II; MANAGEMENT OF
DYSPEPSIA AFTER MINI-GASTRIC
BYPASS
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. Introduction
• Dyspepsia post Mini-Gastric Bypass
(MGB, Billroth II gastro-jejunostomy) may
be erroneously labeled as "bile reflux."
Thousands of Billroth II (BII) patients have
bile that flows harmlessly across their BII
anastomosis every day.
• In 6253 MGB patients, bile routinely flows
across their BII with No symptoms.

4. Introduction
• All patients with a Gastro-jejunostomy
(GJ) have a well described risk of a
variety of GI symptoms (i.e.: burning,
nausea, vomiting, etc.)
• While it is possible that these patients
can develop "bile reflux, " the usual
etiology of dyspepsia following BII is
not bile but the more common of acid
peptic disease (gastritis/ulcer.)

5. Purpose
• The purpose of this study was to
assess the cause and management of
dyspepsia after BII in 6253 MGB
patients.

6. Results
• Management Protocol: MGB patients
suffering from dyspepsia symptoms,
(symptoms that might easily be called
"bile reflux")

7. Results
• Management Protocol: MGB patients
suffering from dyspepsia symptoms,
(symptoms that might easily be called
"bile reflux")

8. Results
• History: Daily Yogurt (protective);
Alcohol/processed meats/"junk foods,
" NSAIDS, Smoking (“Ulcerogenic”),
Labs: H. Pylori, Hgb Fe LFT, s etc.
• Recommend: Yogurt (plain) daily +
probiotics, AVOID: alcohol, cigarettes,
tobacco, NSAIDs

9. Results
• Medical treatment: treatment H. Pylori,
PPI's/H2 Blockers, +/-
Carafate/Bismuth, other antacid
treatment

10. Results
• In 6253 patients, followed for 15 years,
dyspepsia (5%) medical treatment was
effective in all but 3 patients (treated
Braun Side to side Jejuno-jejunostomy
(J-J).

11. Conclusions
• The rising adoption of the MGB may
lead to confusion when surgeons are
faced with post operative BII patients.
• Dyspepsia is relatively common after
gastro-jejunostomy (BII = RNY).

12. Conclusions
• In the vast majority of these cases the
etiology is common acid peptic disease
causing marginal gastritis/ulcer and is
routinely responsive to medical
treatment.
• Failure of medical treatment is rare, but
easily managed by brief laparoscopic
Braun side to side J-J.