Gastric Sleeve Ulcers and Strictures: Treatments, Symptoms

gastric sleeve stomach ulcers

By definition, an ulcer is a break in the continuity of the epithelial lining of an organ while a stricture is an abnormal narrowing and loss of distensibility of a tubular structure. Ulcers and strictures are part of the gastrointestinal complications of gastric sleeve surgery; a restrictive operation that has become the most commonly performed weight loss surgery in the United States.

Stricture after Gastric Sleeve Surgery

The notch on the lesser curvature of the stomach at the junction of the body of the stomach and the pyloric antrum is known as the incisura angularis, and it is the most frequent site of stricture following gastric sleeve surgery showed an incidence rate of 3.5% in 230 patients that had gastric sleeve surgery.

The cause of restraint immediately after surgery is inflammatory edema (swelling) around the region while the late presentation is the result of fibrosis (scar formation) around the incisura angularis. Risk factors include calibration of the sleeve over a narrow tube or over-sewing of the staple line.

Most strictures occur during the first three months of surgery and patient often presents with food intolerance, difficulty swallowing, nausea, and vomiting. The diagnosis is confirmed by a barium study or upper gastrointestinal endoscopy.

Early Postoperative Presentation

For early postoperative presentation, the treatment includes resting the stomach by not taking anything orally, intravenous fluid to prevent dehydration. The symptoms are expected to resolve as the inflammatory edema subsides. Dilatation of the narrow area by endoscopy may, however, be indicated if the above conservative treatment failed.

It’s important to follow the post-op diet to ensure your new stomach can heal properly. For a chronic presentation, the treatment is endoscopic or surgical dilatation depending on the length of the narrowed segment. For a short segment stricture, an endoscopic balloon dilatation is the treatment of choice. More than one sessions of balloon dilatation may be required.

Laparoscopic or open surgical dilatation is indicated for a long segment stricture and when endoscopic dilatation has failed for a short segment stricture. Failure of dilatation may require a gastric sleeve revision surgery.

Symptoms of a Stricture

  • Upset stomach, nausea
  • Puking especially after eating
  • Trouble occurs while swallowing
  • After eating, you feel full for a long time.
  • Trouble eating certain foods
  • Dizziness
  • Abdominal distention

Treatments of Strictures

Stricture treatment is typically re-operating on your stomach.

If you suspect you have a stricture please consult with your operating surgeon immediately. A stricture can develop into more serious complications and even death if left untreated.

It’s important to continue to drink water if you suspect you have a stricture with small sips to ensure proper hydration.

gastric sleeve stomach ulcer and strictures

Ulcer after gastric sleeve surgery

An ulcer is another complication that may occur after gastric sleeve surgery. The lining of the stomach along the staple line may ulcerate leading to burning epigastric pain, nausea, and vomiting. Certain conditions can precipitate the development of gastric ulcers and aggravate the symptoms; these include the use of non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, diclofenac, etc.), smoking, and alcohol intake.

Those whose stomachs contain bacteria called Helicobacter pylori before surgery are also prone to developing gastric ulcers. Diagnosis may involve visualization of the interior of the stomach (pouch) through an upper gastrointestinal endoscopy. Prevention is by avoiding all precipitating and aggravating food substances. Antacids and drugs that reduce acid production in the stomach are the mainstays of treatment.

Symptoms of Ulcers

  • Abdominal Pain
  • Inability to eat you previously tolerated

Treatment for Ulcers

The treatment for ulcers is typically anti-acid medications, sometimes referred to as proton-pump inhibitors. Your physician may also prescribe Carafate to help treat your ulcer. 

Ulcers will typically heal on their own after bariatric surgery.

However, ulcers may become chronic and recur. This is probably the most common reason a patient after gastric sleeve surgery may require another procedure to deal with the ulcer. 

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