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Complications of Gastric Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Kevin M. Schuster, Erik Barquist
The leading cause of recurrent ulcer in nearly 60% of cases is an inadequate or inappropriate operation.27 Inadequate vagotomy is the most common identified cause and is found in as many as one-third of cases. Inadequate resection of antral tissue, which can extend one or more centimeters into the duodenum, can result in the retained antrum syndrome, a rare but highly ulcerogenic cause of recurrence. The retained antral tissue is constantly exposed to an alkaline pH, because an absence of gastric acid in the duodenal stump results in continuous hypersecretion of gastrin from the mucosa. Fasting gastrin levels will be two to four times normal values in these cases and aid in the diagnosis. Antral G-cell hyperplasia and Zollinger–Ellison syndrome may also cause recurrent ulcer, but the fasting gastrin levels will be much higher than those in retained antrum syndrome. Other rare causes are foreign body (stitch) ulcer and gastric cancer. Contributing factors include ulcerogenic drugs, smoking, delayed gastric emptying, enterogastric reflux, bezoar, and primary hyperparathyroidism.
Advances in the pharmacotherapeutic management of refractory peptic ulcers
Published in Expert Opinion on Pharmacotherapy, 2023
Cristina Borao Laguna, Angel Lanas
With the rise of bariatric surgery in obesity, the incidence and prevalence of refractory peptic ulcer in these patients have increased. Approximately 0.6–25% of patients undergoing bariatric surgery (gastric bypass with Y of Roux) will suffer from peptic ulcer [27]. These ulcers are called ‘isquemic ulcer’ or ‘anastomotic ulcer’ or ‘marginal ulcers.’ Only two-thirds of patients who develop them respond to medical treatment, while up to one-third require reconstructive surgery [28,29]. In the case of Billroth II gastrectomy patients, a small proportion of antral mucosa with gastrin-producing cells may remain in the proximal duodenal portion. The alkaline environment stimulates these cells, which increase their gastrin production and therefore the formation of ulcers in these cases. The ‘Retained antrum syndrome’ will need surgical removal of the excluded portion of the antrum to cure [16]. In Figure 1, it is shown the algorithm for managemet of refractory peptic ulcer.