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Ulcers: Risks, symptoms, and treatments

Ulcers: Risks, symptoms, and treatments

Gastric bypass surgery, otherwise known as Roux-en-Y gastric bypass surgery (RYGB), is a weight-loss method. It is used when diet and exercise alone aren’t enough to cause weight loss, or if major health issues are being caused by your current weight. Gastric bypass surgery is one of the bariatric surgery methods that can be utilized.

Other bariatric procedures include: Gastric balloon placement, adjustable gastric banding (Lap-Band), vertical sleeve gastrectomy, and duodenal switch.

Some of the aforementioned procedures limit the amount of food you can eat, others reduce your body’s ability to absorb nutrients from food, and some do both. Gastric bypass surgery encourages weight loss by taking away the majority of the stomach, leaving a small pouch behind, and connecting it to the lower part of the intestines. Having a small pouch for a stomach and bypassing part of the small intestine does two things:

  1. Does not allow the patient to eat much food.
  2. Fewer calories and nutrients are absorbed from the food consumed.

It is important to remember that diet and lifestyle changes are essential to the success of any weight loss procedure. Some individuals may assume that gastric bypass surgery is a quick and easy fix to lose weight, but this is simply not true. There are strict instructions to follow post-surgery that require you to limit food intake and follow further instructions from your surgeon. While gastric bypass surgery is intended to promote weight loss it is possible to overeat and not lose much weight post-surgery. There can also be other serious complications that can occur if there is poor adherence to your post-surgical guidelines.

As with any surgical procedure, some risks and consequences come along with it. One of these consequences can be the development of an ulcer. Ulcers do not go away on their own, it is important to seek the help of a medical professional to help address them.

Risks and Complications to Consider

There are various risks associated with surgery.

There are both short term and long term risks that should be considered before going forward with gastric bypass surgery.

Short Term Risks

  • Blood clots
  • Lung and breathing issues
  • Death (very rare)
  • Excess bleeding
  • Infection
  • Leaks in your gastrointestinal system
  • Adverse reaction to anesthesia

Long Term Risks

  • Gastric pouch ulcers
  • Vomiting
  • Acid reflux
  • Dumping syndrome
  • Bowel obstruction
  • Hernias
  • Malnutrition

Symptoms of gastric pouch ulcers

Symptoms of an ulcer can show up in a variety of ways.

Stomach ulcers can cause different symptoms in each individual, while some do not experience any symptoms at all.

Common symptoms of gastric pouch ulcers:

  • Abdominal pain
  • Difficulty swallowing
  • Discomfort and bloating
  • Indigestion and heartburn
  • Loss of appetite
  • Frequent burping
  • Chronic nausea or discomfort when eating

The most common symptom of an ulcer is pain. It can manifest as dull, gnawing, or burning pain that can be felt from the breast bone to the navel and also in the back. Pain from gastric pouch ulcer is usually worse after eating. Eventually, an ulcer can bleed and cause a hole or blockage to form in the digestive system.

Treatment of ulcers

Common causes of gastric pouch ulcers:

  • H.pylori bacteria
  • Smoking
  • NSAID use
  • Excessive acid production
  • Blood supply problems to the pouch

Depending on the cause, antibiotic treatment in combination with lifestyle changes maybe required.

Over-the-Counter (OTC) Medication

  • Antacids like Tums, Milk of Magnesia, Alka-Seltzer can offer brief relief from the pain that ulcers can cause. They do this by neutralizing stomach acid.
  • Pepto Bismal has been observed to have a protective and antibacterial effect against H. pylori bacteria.

Prescription Medications

Medications can sometimes be helpful in fighting ulcers.

Antibiotics are used when H. Pylori is found in your digestive tract. The antibiotic treatment for an ulcer that has developed after gastric bypass surgery usually lasts 1 to 2 weeks. The purpose of antibiotic use is to kill the bacteria (H. pylori) that is causing the issue. Some side effects of antibiotic use are vomiting, nausea, diarrhea, bloating, indigestion, and loss of appetite.  

Proton pump inhibitors are a form of medication that changes the stomach’s acid production. Prilosec and Prevacid are common forms of this drug.

Mucosal protective medications protect the lining of the stomach from acid, they differ from proton pump inhibitors because they do not inhibit or change the release of stomach acid. Instead, they prevent damage to the lining of the stomach. Common mucosal protective medications are Carafate and Cytotec.

Carafate adheres to the ulcer to make a barrier that allows it to heal and prevents further damage. Cytotec protects the stomach lining by increasing mucus production which protects the stomach lining from stomach acid damage, increasing bicarbonate production which neutralizes stomach acid, and enhancing blood flow to the stomach which promotes healing.

Lifestyle Changes

Changes in your daily lifestyle can reduce your risk of developing an ulcer.

According to a study from 2016, reducing stress in your daily life can lower your risk of developing an ulcer. Managing stress can look like different things for each individual. Consider meditating, practicing yoga, or booking massages as forms of stress relief. If needed, seeing a therapist may do wonders for not only your stress levels but also any mental health struggles. Regularly seeing a mental health professional can arm you with the tools and strategies needed to reduce your stress levels.

Smoking has been seen as a lifestyle factor that can slow down the healing process of an ulcer. It has shown relation to an ulcer recurring again. If you are currently a smoker, it may be worthwhile to quit so the risk of developing an ulcer after gastric bypass surgery is reduced.

Tailoring your diet to avoid enhancing the symptoms of your ulcer can make the healing process more comfortable for you. Food that should be avoided include coffee, milk, alcoholic drinks, and fried foods because they can cause the following:

  • Irritation
  • Heartburn
  • Excessive acid production

It may also be beneficial to include probiotic foods into your diet because they contain bacteria that can improve gut health. A healthier environment will help fight off H. pylori and heal your ulcer.

Always seek a medical professional's evaluation if you develop abdominal pain, especially after gastric bypass surgery.

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Kaelyn Johnson, MPH, RD

Author

Kaelyn Johnson is a Registered Dietitian who earned her Master of Public Health degree from Loma Linda University. She has worked in both a skilled nursing facility and an outpatient dialysis center.

Gintas Antanavicius, MD, FACS, FASMBS

Author

Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.