Stomach Ulcer Before Surgery

[ShrinkingSydney 1]

I was just recently diagnosed with an irritated stomach lining and a small ulcer. I was supposed to be getting my clearances for surgery next Thursday with only one appointment left and about a month left until my surgery date was scheduled. I was getting so excited but now I am really worried. Has this happened to anyone else? How far back is this going to set me?

I am also wavering on which type of surgery to get. I was pretty set on the sleeve because I have GERD ( but I also have a decent-sized hiatal hernia, so that could also be the cause). But I am now leaning toward the bypass for various reasons. My hesitation with the bypass is that I take medication for bipolar disorder and I'm worried about dosages and absorption with the bypass. Are bypasses more prone to ulcers? Or is it just harder to detect once you have them?

Thanks for any advice!

[catwoman7 10,874]

bypasses are more prone to ulcers, sleeves are more prone to GERD. Although the GERD in sleeves is more common than ulcers in bypass. There are a lot of WLS'ers who take meds for bipolar disorder, both sleevers and bypassers. If necessary, they can adjust your meds (change dosage or brand) so you can absorb them.

[lunadreams 22]

19 hours ago, ShrinkingSydney said:

I was just recently diagnosed with an irritated stomach lining and a small ulcer. I was supposed to be getting my clearances for surgery next Thursday with only one appointment left and about a month left until my surgery date was scheduled. I was getting so excited but now I am really worried. Has this happened to anyone else? How far back is this going to set me?

I am also wavering on which type of surgery to get. I was pretty set on the sleeve because I have GERD ( but I also have a decent-sized hiatal hernia, so that could also be the cause). But I am now leaning toward the bypass for various reasons. My hesitation with the bypass is that I take medication for bipolar disorder and I'm worried about dosages and absorption with the bypass. Are bypasses more prone to ulcers? Or is it just harder to detect once you have them?

Thanks for any advice!

I had an ulcer, which was noted to be healing on endoscopy. My surgeon was not concerned because it was not around the part of the stomach on which she would be operating, so that may be a factor.

[RickM 1,747]

Yes, they bypass is more prone, or predisposed to, ulcers than the sleeve (just as the sleeve is predisposed to GERD.,) but they are a different sort of ulcer than what you have. The bypass tends toward marginal ulcers around the anastomosis (junction) between the new stomach pouch and intestines. This is because the part of intestine that is now immediately downstream of the stomach is not resistant to stomach acid like the duodenum - the upper part of the intestine immediately downstream of the normal stomach, which gets bypassed along with the remnant stomach in the RNY. Consequently, that anastomosis is very sensitive and prone to ulcers, which is the root of the "no NSAID" rule that permeates bariatrics - you don't want to take any medication that could irritate that anastomosis (there are other meds that may be limited, too, but NSAIDs are the most common class.)

What I would be concerned about is what caused your ulcer, and whether that cause would be relieved (or exacerbated) by your surgery. Similar to your hiatal hernia and GERD - fixing the hernia will likely correct your GERD and you will be back to "normal" - no more predisposed to it if you get a sleeve, but still possible. One of the problems with the bypass is that it leaves you with a blind remnant stomach and upper intestine, which can't be easily monitored with an endoscopy, so if something develops in that blind section, you may not know about it until things have progressed more than you would like them to progress (possibly to a cancer.)

Some express a dislike for the sleeve because if they have a resultant reflux problem then it could lead to Barret's esophagus and possibly cancer, which is a fair concern; however, that is something that can be easily monitored endoscopically if those symptoms develop, and can be treated; problems that may develop in the blind stomach or intestines of the RNY may not be caught until it is too late to treat effectively, so there is a trade off there.

You are somewhat caught in the middle, with some contraindications for both of the common WLS procedures. This is where some serious talk, and understandings, with your medical team is appropriate to really get a good handle on your problems going into this, and how those may play out in the future. I/m not so sure that I would be comforted by the matter that the surgeon may be able to work around a problem (such as an ulcer) if that problem is likely to reoccur 5-10 years in the future, and possibly worse - the surgeon is out of the picture by then, but you aren't.

There is another alternative that might be worth considering, which would be the duodenal switch - it uses a sleeve, so it doesn't leave a blind remnant stomach, but due to its' malabsorption component, they typically use a larger version of the sleeve which is less prone to GERD problem. Your surgeon may not offer it (it's a more complex procedure, so many surgeons don't offer it) but it may be worth looking into to see if that fits your need.

Good luck,

[ShrinkingSydney 1]

Thank you for the information. You have given me much food for thought. My surgeon does offer the duodenal switch and it was what I was considering in the first place. In my initial consultation with my doctor, he said he was fine with it but felt it may be a little too drastic for me and that a sleeve or bypass might fit better for me (which with my high BMI, I don't understand). I have made an appointment with my surgeon to talk about the switch and the sleeve and the ulcer issue. Thanks again for the great info!