Re: pain

Posted By HFHSM.D.-rf on April 07, 1998 at 00:04:35:

In Reply to: pain posted by Jim on March 31, 1998 at 16:36:19:






I had a Bilroth ll {spelling?}  four years ago, and a Rue-n-y {Spelling?}  two  years ago.  I have about 40% of my stomach.  I have been having pain after eating that goes away after an hour or two.  After trying many medications, I am now on Creon which seems to work pretty well most of the time.  I understand that that consists of natural enzymes and I am wondering if more would be better.  Is there any test to show that I need  enzymes  and which ones?
_____


Dear Jim,
Thank you for your letter. A Bilroth II surgery is usually performed as treatment for complicated ulcer disease.  The acid producing portion of the stomach is remover and a loop of small intestine is attached to the gastric remnant.  As a result of this hookup, bile acids and pancreatic secretions can now enter the stomach (Usually these substances are secreted downstream from the stomach and do not come into contact with the gastric lining).  In a small number of patients the bile acids irritate the gastric lining causing pain and sometimes bleeding.  The only effective ttreament for this problem is to take down the Bilroth II hookup and replace it with a Roux-en-Y anastomosis in which a different loop of small intestine is attached to the stomach.  With the Roux-en-Y bile acids can no longer enter and damage the gastric lining.
I do not know why you should have pain after eating.  If not yet performed, you should have a repeat endoscopic evaluation of your stomach as well as an ultrasound of your gall bladder..
Creon is a medication that contains pancreatic enzymes.  It is usually given to patients with pancreatic insufficiency to treat malabsorption.  It is conceivable that you have a relative ,alabsorption as a consequence of your surgeries.  If you have ever had pancreatitis or if you have calcifications of your pancreas, these problems could also explain why you have malabsorption.
Regarding your question about taking more creon, the medication can usually be increased if you are not yet taking large doses.  This question is best answered by your personal physician.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by a physician.
We would be happy to meet you personally in order to better characterize the cause of your symptoms and to provide reassurance. If you wish to be seen by a gastroenterologist of the Henry Ford Health System, please call [phone] and request consultation with Dr. Muszkat, one of our experts in Nutrition and Intestinal Diseases.
HFHSM.D.-rf
*keywords: gastric surgery, Roux-en-Y, Bilroth II,pancreatic insufficiency
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