Rando Pouch Question - RNY

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Does the new pouch after RNY make any stomach acid or is that all done via the old stomach?

Edited January 13, 2019 by Kimmie K

[GradyCat 3,696]

My guess is that the pouch IS the new stomach. Oh wait, I'm thinking of gastric sleeve where the new "pouch" is the new stomach but you might be talking about Gastric Bypass where the pouch is in addition to the old stomach. Good question. I had gastric sleeve a month ago and I'm having acid reflux whenever I lay down.

[🅺🅸🅼🅼🅸🅴🅺 296]

1 minute ago, GradyCat said:

My guess is that the pouch IS the new stomach. Oh wait, I'm thinking of gastric sleeve where the new "pouch" is the new stomach but you might be talking about Gastric Bypass where the pouch is in addition to the old stomach. Good question. I had gastric sleeve a month ago and I'm having acid reflux whenever I lay down.

Yep! I should’ve specified so I edited my post to include RNY.

My surgeon said reflux is rampant with sleeve patients and the #1 reason folks come to him for revisions to RNY. Some people just can’t get a handle on it 😥 I hope you can get some relief.

[mousecat88 2,281]

It doesn't make stomach acid. Your bile is connected to the old intestinal limb and digestion occurs at the Y, not in the stomach. There's mucus in the stomach that helps with breakdown.

Sent from my SM-G930R4 using BariatricPal mobile app

[mousecat88 2,281]

Basically the pouch just holds food briefly and then it passes. Which is why you need to chew well.

Sent from my SM-G930R4 using BariatricPal mobile app

[🅺🅸🅼🅼🅸🅴🅺 296]

3 minutes ago, mousecat88 said:

It doesn't make stomach acid. Your bile is connected to the old intestinal limb and digestion occurs at the Y, not in the stomach. There's mucus in the stomach that helps with breakdown.

Sent from my SM-G930R4 using BariatricPal mobile app

Ohhhhh! I couldn’t find that info anywhere. Now a few more things make sense. Thanks!

[RickM 1,753]

It makes some, but not a lot - the majority is made in the bypassed remnant stomach as most of the Protein pump ports (those buggers that inject the acid, which the protein pump inhibitors, PPI's, inhibit,) are clustered around the pyloric valve which is part of the bypassed stomach. This is also why the sleeve is more prone to acid reflux, as there is more stomach is removed than acid production capacity, so in some cases the patient's body doesn't fully adapt. RNY folks are also subject to acid reflux and GERD, but not as often as the VSG.

The downside of this for the RNY is that the part of the small intestine where the pouch is attached is not resistant to stomach acid as the duodenum is (that's the part of the small intestine immediately downstream of the stomach, where the bile is introduced to neutralize the acid before things proceed downstream.) This means that the anastomosis is easily irritated by what acid is there and subject to ulcers, which is why stomach irritating medications such as NSAIDs are a big NO-NO with the RNY, but are better tolerated by the sleeve based procedures like the VSG and DS.

[Ed_NW 684]

1 hour ago, RickM said:

It makes some, but not a lot - the majority is made in the bypassed remnant stomach as most of the Protein pump ports (those buggers that inject the acid, which the Protein pump inhibitors, PPI's, inhibit,) are clustered around the pyloric valve which is part of the bypassed stomach. This is also why the sleeve is more prone to acid reflux, as there is more stomach is removed than acid production capacity, so in some cases the patient's body doesn't fully adapt. RNY folks are also subject to acid reflux and GERD, but not as often as the VSG.

The downside of this for the RNY is that the part of the small intestine where the pouch is attached is not resistant to stomach acid as the duodenum is (that's the part of the small intestine immediately downstream of the stomach, where the bile is introduced to neutralize the acid before things proceed downstream.) This means that the anastomosis is easily irritated by what acid is there and subject to ulcers, which is why stomach irritating medications such as NSAIDs are a big NO-NO with the RNY, but are better tolerated by the sleeve based procedures like the VSG and DS.

VERY good explanation! Thanks... You've done your homework.

[Biddy zz 🏳️🌈 1,004]

A couple of extra points. I thought I had reflux (was just indigestion) and my surgeon showed me a picture of my newly arranged organs. He said a small amount of stomach acid is made in the new pouch, but really small. This is hydrochloride acid, plus sodium chloride and potassium chloride. But acid is still made in the old detached stomach too. Bile comes in below the bile - this neutralises the acid and is primarily for fat digestion.

One of the best side effects of RNY - it really improves things if you vomit. Very little stomach acid, no bile, so the food tastes almost unchanged from when you swallowed it. I HATE vomiting, perhaps almost a bit phobic, so the RNY has been a wonderful cure - I got food poisoning from watermelon and found that when it doesn’t taste like vomit, it doesn’t seem to bother me at all!