Bile reflux, respiratory aspiration, never had reflux pre surg.

Here I am almost 10 years out and I am having nasty complications with reflux.  It appears I have had "silent" reflux for years- Even if you don't have heartburn-see if  you have any of these symptoms: 

Recurrent cough (esp at night),

throat clearing,

hoarseness,

trouble breathing -taking a deep breath,

ear aches, sore throat,

Trouble swallowing

 

Mine started with post nasal drip about 8 years ago.  Now I am waking at night choking on bile,  horrible burning at the juncture between my esophagus and trachea and shortness of breath.  Next I start with the rigors- shaking chills and aching where you can't get warm, I end up in the tub in ho****er shaking.  My temp will spike to 103+ for about 5 hours.  Oxygen saturation of 85% at rest and extreme shortness of breath with activity.   Tight cough for about 24 hours then I start coughing up bloody sputum.

Dr says I'm aspirating bile which is burning my lungs- the inflammation of the burning causes the temp and rigors.  Then the lung tissue sloughs off in sputum.

So far the testing has shown my lower esophageal sphincter is flaccid so it can't stop stuff from leaving the remnant stomach backwards up the esophagus.  I don't make much acid in the remnant stomach but for some reason bile is going back up the duodenum into the stomach.  

I don't have the results back from the 24 hour ph/manometry test but I KNOW it's bile- it tastes like bile.

 

There was a message 3/27/11 from a "deactivated member" from NC who I would love to get in contact with.  Does anyone know who she is?

 

If you have these kind of problems let me know- I feel alone in this.

 

Pup

I would also have them test you for vocal cord dysfunction as a result of the GERD. Why have they not removed your gallbladder yet? If you eat large amounts of food at each sitting your pouch will force the excess up into your esophagus.

My esophageal sphyncter has never worked so I'm familiar with all those symptoms.

I'm so sorry you are having to go through this!

They took my gallbladder with the original surgery.  That's what is weird.  I've also tried and failed PPI's.  They don't do a thing for bile & my remnant stomach doesn't make much acid anyway.

What we are trying now is Reglan at the evening meal.  It speeds motility.  I am worried my small bowel is kinking and then the bile back flows.  I do know I have very slow gastric motility.

 

I wonder what makes the esophageal sphincter not work?

Pup 

Typically, GERD is not an issue with RNY post ops.  BUT, I do know a few RNY post ops, 2+ years out, you live daily on Prilosec.  At 6 years out, I began taking OTC type Prilosec daily when my cardio doc said to take a 81mg baby aspirin daily. I spoke to my surgeon's nurse about this, and she said to ONLY take this baby aspirin 30 minutes or later after taking the Prilosec.  I found generic 20mg Prilosec at my local Kaiser pharmacy, 28 capsules for $5.  If you can't find them locally, Ebay has some generics also, made in India--I'd do a google on the pharmacies that make them though.  Stick to a larger pharmaceutical co. DAVE

Dexilant may work better. Sleep at least 30 degrees incline. No eating after 6:00pm.  I think small meals will help.  I can't believe that the RYN is contributing to this since it is suppose to lessen GERD.  I would be using advair maybe 500 twice a day and a rescue inhaler to bring those sats up.  Are you seeing a good pulmonoligist?

Hello I hope this finds you well . I am 16 yrs post op from RNY . I developed the symptoms you describe after having the flu 7 months ago I was sent for MRI and then to ENT who diagnosed me with silent LPR reflux though I have never felt like I had heartburn . He tried to put me on acid reducer and I explained I should not have an acid problem my pouch doesn't produce acid ? I did my own research and found a bariatric Dr. who suspected a hiatal hernia and scheduled me for endoscope and bravo acid test . He found a gastrogastric fistula and said acid test was low acid but he believes it is bile not acid . I was confused since I had my gallbladder out 29 years ago but apparently you still produce some bile . Anyway my dentist said this explains why I've lost so many teeth in the past 3 years . I finally have an answer to weight regain and dental problems all to a hoarse voice . I'm having my fistula and old pouch taken out and getting a new pouch Tuesday .