Anna once had a well-proportioned figure of 59 kg, but after several births, her weight continued to increase and she suffered from gastroesophageal reflux disease (hereinafter referred to as “GERD”) for a long time. She is 1.62 meters tall and weighs 113 kilograms. She has reached the diagnostic criteria for morbid obesity. Obesity poses a serious threat to her life.
During a diagnosis, the doctor suggested to Anna, who was almost desperate, that it might be possible to solve her troubles through gastric bypass surgery. Gastric bypass surgery is also called bariatric surgery, and its success rate is quite high. There are more than one gastric bypass surgery options for Anna. Finally, she decided to undergo Roux-en-Y gastric bypass surgery (hereinafter referred to as R surgery), which is also the most effective and long-lasting gastric bypass surgery for weight loss. .
The main task of R surgery is to use the patient’s own stomach tissue to create a “small pocket” at the top of the stomach. This “small pocket” is connected to the stomach, carries the esophagus above and the small intestine below, and can only hold a small amount of food at a time. The rest of the stomach tissue remains in place, still connected to the small intestine. After the operation, food no longer passes through the original gastrointestinal tract, but is digested through the passage of the esophagus-the “small pocket”-the small intestine. The original gastrointestinal pathway became an idle bypass, hence the name of gastric bypass surgery.
After the operation is successful, the patient will lose weight for the following reasons. One is that the volume of the “small pocket” is much smaller than the volume of a normal stomach, which limits the amount of food the patient eats each time and avoids excessive calorie intake. The second is that most of the small intestine is no longer in contact with foods that have been digested in advance through the stomach, so some of the nutrients cannot be absorbed by the small intestine, but go to the large intestine and other parts, and finally are directly excreted from the body. Regardless of the slimming effect, R surgery will also bring other benefits to patients, that is, it cures GERD by the way.
Anna’s operation was very successful and she did not suffer from any complications after the operation. In the first year after surgery, she lost 34 kilograms. The success of the operation made Anna think that she had won the war against obesity.
Over-reduction causes problems
One year and three months after the operation, Anna came to the hospital again. She looked very haggard, with a lingering feeling of weakness and fatigue. She told the doctor about her physical conditions such as decreased vision, easy bruising, and raised rashes on her limbs in the past three months. What bothered her most was that her weight continued to lose, which was beyond the expected results of the surgery.
Most patients undergoing gastric bypass surgery will reduce their weight to the ideal range within a year, and then there will be basically no major fluctuations. But Anna was already 46 kilograms lighter at the time, and became sick and sick from her original stoutness. The sudden weight loss made her very anxious and even suspected that she had cancer. This is not surprising, because few diseases other than cancer cause a person’s weight to continue to drop so fast in a short period of time.
The doctor arranged a CT scan of Anna’s abdomen and pelvis, and the results showed no abnormalities. The results of upper gastrointestinal endoscopy and colonoscopy also showed that the newly created gastric bypass had no lesions and there was no possibility of colon cancer.
At that time, all the examination results were normal, so what caused Anna’s continuous weight loss? Finally, the doctor found a clue in the blood test results: Anna is seriously deficient in vitamin K, and the main symptom of vitamin K deficiency is easy bleeding. Not only that, her vitamin A level is also very low, which can explain the reason for her decreased vision-good vision requires enough vitamin A to maintain. At the same time, the lack of vitamin A and vitamin K is not common, and Anna insists on supplementing multivitamins (including vitamin A and vitamin K) for a long time. The doctor speculated that Anna’s intake of these two vitamins was sufficient, and the problem was that her body could not absorb them.
The main part of the stomach
Adjustable gastric band surgery. Wrapping a flexible band around the upper part of the stomach is like putting a belt around the stomach, dividing the stomach into two parts with a small opening between the two parts to allow food to pass through. When eating, food fills up the smaller upper part of the stomach quickly. When this part of the stomach is filled and expanded, it will stimulate the nerves of the stomach and transmit signals to the brain’s satiety center. The brain’s regulation center will make people feel full for several hours.
Sleeve gastrectomy. Cut the large curvature of the stomach vertically to form a “small pocket” of about 150 ml, which can only hold 110 to 140 grams of food
When enzymes miss the food
According to Anna, she felt 3 to 4 obvious gastrointestinal peristalsis almost every day after the operation, and her stools were always shiny. This is medically called steatorrhea, or malabsorption syndrome.
For early humans, fat was a very scarce source of energy. Therefore, human beings have evolved to this day, and our efficiency in absorbing fat from food is very high. There is a lot of fat in Anna’s feces, which shows that she cannot absorb the fat from food normally. In view of the fact that vitamin A and vitamin K are only soluble in lipids but not in water, the inability to absorb fat means that the two vitamins cannot be absorbed as well, so vitamin A and vitamin K deficiencies are unsolicited.
Some people think that the stomach is responsible for digesting food. But in fact, most of the digestion process is done by the pancreas. Carbohydrates, fats and proteins in food can only be absorbed in the small intestine after they are broken down into basic small units under the action of various enzymes secreted by the pancreas. Those with impaired pancreatic function, such as patients with chronic pancreatitis, often have a lot of oil in their stool. But Anna’s pancreas is healthy, so the problem must be elsewhere. The doctor suspected that Anna’s digestive system might be “out of sync”.
If the human body wants to digest food normally, it needs all parts of the digestive system not only to work in the right way, but also to work at the right time and position, just like a carefully choreographed ballet. Simply put, the asynchrony of the digestive system means that its parts are not working properly at their respective time points or positions. This happens from time to time in patients who have undergone complicated gastrointestinal reconstruction surgery such as R surgery. In Anna’s newly created gastrointestinal tract, food directly enters one branch of the small intestine through the “small pocket”, while various digestive enzymes from the pancreas reach the other branch of the small intestine through the stomach. Therefore, the food that meets the digestive enzymes in the small intestine for the first time leaves the small intestine before it can be digested (and cannot be absorbed by the small intestine), which means that Anna will excrete whatever she eats.
Aiming at the problem that the food that Anna ate was in contact with digestive enzymes too late to be digested, the doctor prescribed pancreatin tablets for her and asked her to take them with each meal. In this way, the food is decomposed and digested by the pancreatin before reaching the small intestine, and can be absorbed smoothly when it reaches the small intestine. Only a few days after taking the medicine according to the prescription, Anna’s stool became normal and her weight stopped losing. After a few weeks, her vitamin levels also returned to normal.
Everything is okay for Anna now, but the catch is that she may spend the rest of her life with pancreatin tablets.