Surgery For Peptic Ulcers

Surgeons working on a patient in an operating room
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A peptic ulcer is a sore on the lining of your stomach or duodenum. Rarely, a peptic ulcer may develop just above your stomach in your esophagus. Doctors call this type of peptic ulcer an esophageal ulcer.

The cause of the majority of peptic ulcers is H. pylori, a bacterial infection that was discovered in 1982 by two researchers, Barry Marshall and Robin Warren of Perth, Australia. it had been a long-standing belief in medical teaching and practice that stress and lifestyle factors were the major causes of peptic ulcer disease.

However, as mentioned above, treatment with antibiotics along with other medications generally heal peptic ulcers. There are several types of medicines used to treat a peptic ulcer. Your doctor will decide the best treatment based on the cause of your peptic ulcer.

In many cases, treatment with antibiotics and other medications heal the ulcers quickly and effectively. Eradication of H. pylori prevents most ulcers from recurring. Surgical intervention is rare. However, some people do not respond to antibiotics prescribed to heal the ulcer, or they develop complications from the ulcers such as perforation, bleeding, and obstructions. They may require surgical intervention.

Perforation is a hole in the wall of your stomach or small intestinal. A perforated ulcer is a very serious condition where an untreated ulcer can burn through the wall of the stomach (or other areas of the gastrointestinal tract), allowing digestive juices and food to seep into the abdominal cavity.

Bleeding occurs if there is a broken blood vessel in the stomach or small intestine. An ulcer has eaten its way into a blood vessel. This will cause red or black blood in vomit or in your stool.

A blockage occurs when food is prevented from moving from your stomach into your duodenum. Ulcers located at the end of the stomach, where the duodenum (start of the small intestine) is attached, can cause swelling and scarring, which can narrow or close the intestinal opening.

Food is then prevented from leaving the stomach, resulting in vomiting the contents of the stomach.

The types of surgery that may be performed for peptic ulcers are vagotomy, pyloroplasty, and antrectomy.

Vagotomy

In this surgery, one or more branches of the vagus nerve, which transmits messages from the brain to the stomach, is cut. Interrupting these messages reduces acid secretion. However, there can be side effects such as severe, persistent abdominal pain, vomiting, or diarrhea. The surgery may also interfere with stomach emptying. The newest variation of this surgery involves cutting the only parts of the nerve that control the acid-secreting cells of the stomach. This avoids the parts of the nerve that influence stomach emptying.

Antrectomy

In this surgery, the lower part of the stomach (antrum) is removed. This section of the stomach produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes a surgeon may also remove an adjacent part of the stomach that secretes pepsin and acid.

A vagotomy is usually done in conjunction with an antrectomy.

Pyloroplasty

This surgery enlarges the opening to the duodenum and small intestine (pylorus), which enables stomach contents to pass more freely out of the stomach. A vagotomy may also be performed along with a pyloroplasty.

Sources:
"Common GI Problems: Volume 1." American College of Gastroenterology. 22 Aug 2007

"H. pylori and Peptic Ulcer." NIH Publication No. 05–4225 October 2004. National Digestive Diseases Information Clearinghouse (NDDIC). 22 Aug 2007

"What I need to know about Peptic Ulcers." NIH Publication No. 05–5042 October 2004. National Digestive Diseases Information Clearinghouse (NDDIC). 22 Aug 2007

William D. Chey, M.D., F.A.C.G., A.G.A.F., F.A.C.P., Benjamin C.Y. Wong, M.D., Ph.D., F.A.C.G., F.A.C.P., "American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection." doi: 10.1111/j.1572-0241.2007.01393.x. American College of Gastroenterology. 22 Aug 2007

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