Marginal/anastomotic ulcer anyone?

[eudys3 27]

I had RNYGB on 7/19/16. I still say it is the greatest surgery I have ever had. My BMI is down from 37 to 21.

I had no problems until I had to go to the ER on 4/10/18 with horrific abdominal pain, nausea, and vomiting. My surgeon put me on Prilosec and Carafate for 6 weeks, but I found out later the Prilosec caps were not bioavailable and just went through without being effective. So on Mother's Day I went back to the hospital for pain control and an upper scope to look for a marginal ulcer. Unfortunately the GI MD had no expertise in looking for marginal ulcers and said my scope was normal. So, I had 6 more weeks of unbelievable pain. My surgeon said maybe I had gallbladder disease so I had my gallbladder removed on 5/29/18. Did not help my pain at all. Finally, my surgeon referred me to a bariatric subspecialist who repeated my upper scope, and he found my marginal/anastomotic ulcer.

This is potentially very serious in that the ulcer could perforate and require emergency surgery. I am concerned because I was pain-free after starting Prilosec liquid for the first four weeks, but the crippling pain has returned. My patients compliment me on my weight loss, but nausea and pain is a horrible way to do it!

Does anyone else have experience with having a marginal ulcer?

[RickM 1,747]

I's so sorry that you have gone through all of that, but I'm really surprised that they had such a problem finding it, as that is the classic place for ulcers to form on an RNY, and that should be the first place they look.

With the Prilosec, was that indeed a capsule, as opposed to the little oblong pills that they often provide (I have mostly used the OTC generic version, so that's what I'm mostly familiar with). I can understand a capsule may not dissolve properly within the pouch, but don't most regular pills work normally (other than possibly time release meds)? I would think that the medication form (pill, capsule, liquid, etc.) would be specified on the Rx if it were critical. (Note to all of us - get friendly with your pharmacist and ask questions!)

Bit confused and concerned on the treatment you have been getting, but best of luck in getting everything resolved...

[Missouri-Lee's Summit 1,256]

My daughter is a PharmD and, believe me, I ask questions. I am sadly not surprised that you were given a drug with poor availability. Omeprazole capsules are all delayed-release. They are dosed at 10mg, 20mg, or 40mg. There's is also an oral suspension available at 2.5mg or 10mg -- also delayed-release. Omeprazole has one tablet dosed at 20mg, delayed-release. When will other medical specialties catch up with the pharmacokinetics* of bariatric medicine? Not only did you pay good money for some "bedpan bullets" but omeprazole has plenty of unpleasant side effects (for some people).

Wait. Did I read something wrong? Did you say your bariatric surgeon prescribed omeprazole for you knowing that the tabs, caps, and oral suspension (liquid granules) are ALL delayed-release? Incredible.

**refers to the movement of drug into, through, and out of the body—the time course of its absorption, bioavailability, distribution, metabolism, and excretion.

As for the sucralfate (Carafate), did you only take it for those initial 6 weeks? Sucralfate has numerous drug interactions and side effects. Hyperglycemia is one side effect. Bezoars are another; however, most people usually have some kind of medical condition that predisposes them to bezoars (such as delayed gastric dumping).

I've had my gallbladder out, too. What are you being given for your ulcer pain now? I'm a chronic pain patient.<sigh>. I've been taking morphine to control my pain for years. You should not be allowed to suffer this much. Whatever you're taking now is not strong enough -- and doesn't appear to even come close to touching your pain.

I've never actually heard of anyone with a marginal/anastomotic ulcer. I have nothing but empathy for you. I'm also fearful that someone will drop the ball again. I'm furious with that gastroenterologist for unequivocally "proclaiming" that your scope was normal. One of my three sons (two are medical doctors, btw), had eosinophilic esophagitis so bad that his esophagus was close to severing. That son, weirdly enough, is a GI pathologist now. I wish I could say more to comfort you. Again, I have nothing but empathy and concern for you. Please keep us posted.

Edited July 22, 2018 by Missouri-Lee's Summit

[Frustr8 7,886]

I am a future RnY myself and c will be following your story. I wish there was more I could offer. I am on Dexilant, omeprazole did not do it for me.Now I am concerned if there is another form of Dexilant like a liquid for me post surgery? This is something I will have to look into. Keep all of us pisted, please?

[Missouri-Lee's Summit 1,256]

Dexlansoprazole only comes in delayed-release capsules, 30mg and 60mg. Who prescribed this for you? I wonder if this doctor is aware that delayed-release medication won't be as effective as immediate-release meds after you have your bypass.

If you can't swallow the capsules whole after surgery, (I swallowed all my meds whole, including my horse pills) you can open the capsule and sprinkle the contents into a little applesauce and swallow it immediately without chewing. As you know, sometimes certain medicines can't be crushed or opened. It's okay for this one.

[Frustr8 7,886]

My gastroenterologist, I take 60 mg, I 'll try swallowing whole , usually don't have trouble swallowing pills, if not. I guess I will put it in applesauce or CreekImp recommends sugar free cool whip.

[Ronnysgal 56]

Sorry to hear about your sufferings. I am about 1 year and 4 months out from my Gastric Bypass and have had a horrific go of it. I have had to have multiple abdominal scans and throughout the last 6 months it has been, well devastating. You can see from the pictures below "sorry to be graphic with photos" but want people to understand this is something that can happen. It does not happen to everyone, so if you are going to have the Bypass, do not automatically assume this will happen to you. Unfortunately mine will not go away and perforation is always a possibility for me.

I never had stomach ulcers pre-surgery and my Bariatric Doctor is man enough to say the surgery is the cause of the ulcers. Since I am malnourished, extremely weak all the time, and now am consistently battling these deep bleeding ulcers you see below, we are looking at doing a reversal soon. If my insurance company will pay for it as I have had to come up with well over 15, 000 out of pocket for the last few years and am unable to continue financially at this pace.

I was taking Omeprazole and it was not until I stopped taking it that the ulcers became dominating, so I am unsure if it was keeping them at bay or not. I take 2 Protonix everyday as well as Carafate. I long for the day of reversal as this has not been a good experience for me. I am glad I have a good surgeon.

My stomach photos

I   

[Hoping052017 97]

I had to go in for a small bowel resection after a lot of pain as well. Thankfully, my doctor knows what he's doing. He ended up putting me on I think it's Privolex??? It's a form of Omeprezole, but more potent and the other that was mentioned above that Carafate. They actually had to basically do exploratory surgery on me. I was throwing up everything and had no appetite and it was nuts and I was hurting so bad. Dr. Mourot said that sometimes with an RNY a few people have problems with what he referred to as the "candy cane" part of the surgery. So they have to go in and remove that part and 9 times out of 10 they don't have any more problems. so that's what he did for me and that's when he found the small ulcer that none of the scopes had seen.

As for the delayed release of the Omeprezole, that, I was told was what was supposed to be happening. they wanted a continual dosage of the anti acid medicine to ward off excess gas and nausea and ulcers. i've always had excess acid in my stomach anyway, so the ulcer didn't surprise me. But he did stop the Omeprezole (I was supposed to be able to get off of it at a year anyway) but was put on a stronger anti acid med plus the carafate (which I never could figure out how to time with all the other medications i have to take for my mental issues and my back and Fiber issues) So, hopefully only 2 more months of the anti acid meds. I've been doing well since the small bowel resection though!

Good luck to you!

[Ronnysgal 56]

Hi Hoping,

Thank you for the comment. I have already had my physician diagnosis me with candy Cane Syndrome in Feb of this year and had the bowel resection done and it accomplished nothing at all. The ulcers have never went away and they keep increasing. It is so sad. I could understand if I was smoking or using ansaids or doing anything that was not following the rules but that is simply not the case.

I am on Protonix which is similar to what your are taking as well as Carafate and was on an even stronger drug called Cytotec of which none are working. I am so ready for the reversal that I could scream.

I sure hope your situation works out. I am about a year out past you and my physician is the leading physician in my state and bless his heart my last visit he said he was dumbfounded but it was clear with all the facts, tests and labs that I was speaking the truth.

[Hoping052017 97]

I'm so sorry to hear that. I usually dumbfound my doctors as well. Even since childhood. I hope your doc finds a solution for you!

[Ronnysgal 56]

Thanks bunches

[eudys3 27]

Just an update-

The pain has improved since resuming Carafate. I am continuing omeprazole 40mg twice daily & famotidine 40mg at bedtime.

Marginal ulcer healing takes about 3-6 months with immediate-release omeprazole (Zegerid or compounded omeprazole w/ sodium bicarbonate) versus 11 months or more with the timed-released/extended-released capsules or tabs that are available over the counter. Perhaps those of you that have not found relief w/ rx have not been given the correct meds.

[Frustr8 7,886]

Hmmn having more sorrows than I expected, you go into things so hopeful, thought I really knew it all but Prcious Puch,is still teaching ME how SHE wants things.

[Ronnysgal 56]

I sure hope you are okay Frustr8. I have gained a little of my weight back after reversal and am so glad but now trying to maintain and stay on top of it. I am feeling a lot better but lately even my reversal has not been able to keep me from nausea and vomiting so I am convinced it is the severe ulcers that are still having their way with me even though on meds.

Stay hopeful. keep your chin up.

[Frustr8 7,886]

Not really , vomited until 3am, even the popsicle I ate afterward came back up. Tried to take it easy today maybe 40oz all day, tried to drink Premier Protein in flavor I used to like , just can't hack it. half left, I feel rotten, chest still sore from last night. And rotten son begging me to make him a Peanut Butter cake. They gave me until. tomorrow morning, if my happy butt isn't doing better , I hot to find someone to take me down to Columbus 50 miles away. Fearful I need the EGD scheduled for next Friday sooner , maybe I have a stricture.