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What is dumping syndrome?
One of the key features that helps control calorie intake after Gastric Bypass is the fact that food leaves the tiny pouch into a section of the small intestine called the jejunum. This pathway for the food is the "Roux-en-Y" part of the full name for the procedure and it matters because the jejunum is simply not made to handle concentrated calories, especially refined sugar. The effect of this is that if a person consumes concentrated sugar after a gastric bypass (such as ice cream, chocolate candy, or a soda) the presence of the sugar in this segment of intestine will create a reaction called dumping syndrome that affects the whole body.
An episode of dumping shows up as palpitations (i.e. heart racing), a sweaty and clammy feeling, cramping abdominal pain, diarrhea, and then a feeling of weakness during which the person simply must lay down for an hour or so until it passes. Dumping syndrome is not dangerous but it feels awful. It is not exactly a side effect in the sense that it works in a beneficial way by steering patients away from that type of food.
Patients with an Adjustable Gastric Band do not usually have dumping syndrome.
What happens to the lower part of the stomach that is bypassed?
We leave it in place with an intact blood supply so that it remains healthy and unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food—it makes Intrinsic factor (necessary to absorb Vitamin B12) and contributes to hormone balance and motility of the gut in ways that are not entirely defined.
What important digestive functions do people lose when the lower stomach is bypassed?
In normal anatomy (i.e. no surgery) and in gastric bypass patients, absorption of nutrients takes place in the small intestine. In the Gastric Bypass the mixing of digestive juices (i.e. bile and pancreatic juice) with nutrients and the absorption of those nutrients still happens. The capacity and acid production of the lower stomach are to help a person digest large bulky meals—this ability was necessary in evolutionary times when meals were not regularly available but it represents excess capacity in today's society. The bypassed stomach and small intestine do play important roles in the absorption of Iron, Calcium, and Vitamin B12—thus we require the patients to take supplements and we follow blood levels of these and other nutrients.
What will all the staples do inside my abdomen? Is it OK in the future to have an MRI test? Will I set off metal detectors in airports?
The first thing to understand about the staples used on the stomach and the intestines is that they are very tiny in comparison to the staples you will have in your skin, or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium that is so small it is hard to see other than as a tiny bright spot. Because the metals (titanium or stainless steel) used are totally inert in the body, people are not allergic to the staples and they do not cause any problems in the long run. The staple materials are also non-magnetic which means that they will not be affected by an MRI and they will not set off airport metal detectors.