Monday, March 22, 2010
Should I avoid Non-Steroidal Anti-Inflammitory medicines after my bariatric operation?
The short answer is it depends on which operation you have chosen.
This class of drugs included Ibuprofen, Naprosyn, Motrin, Aleve, Meloxicam, Mobic, Celebrex and several other medicines. Asprin has some similar side effects of gastric irritation.
I do not know of any reason why patients that choose to have an adjustable gastric band or a gastric sleeve operation should not take these medicines. However I believe that a gastric bypass patient should avoid these medicines for life if at all possible.
In general patients that have an adjustable gastric band or a gastric sleeve procedure may take these medicines. Of course there are risks of a gastric ulcer, bleeding or cardiovascular risks but that is the same as for people that do not have a bariatric operation.
For gastric bypass patients I suggest they avoid all of these medicines for life unless it is really medically necessary.
That is because these all can cause ulceration in the gastric pouch which may result in scarring and narrowing at the connection between the gastric pouch and the small intestine. This can result in vomiting and may require dilation of the narrowing by a special balloon during an endoscopy, (passing a scope into the through the mouth into the stomach).
Let me tell you a story to demonstrate what I mean. Several years ago I had someone who had a gastric bypass operation a few years before in Colorado. She returned to Ohio where her family lived and came into our emergency room with complaints of vomiting. She had also lost a lot of additional weight over recent weeks and she looked dehydrated as well. She had been taking a few Naprosyn tablets daily for pain in her knees. She told me no one had told her she should not take non-steroidal anti-inflammatory medicines. I admitted her to the hospital and looked into her gastric pouch with a scope the following day, I found that she had a very small opening that a pencil point could not even go through. I was able to pass a guide wire through and into the small intestine and then passed a dilating balloon across the narrowing. After inflating the balloon I was able to dilate this area. She did well for a few days but soon this narrowed again. I dilated the area again only to have it narrow again a few days later. Eventually I had to take her to the operating room to make a completely new connection between the gastric pouch and the small intestine.
Also this ulcer may cause very significant bleeding and even perforation with leakage of gastric contents into the abdomen requiring an emergency operation.
For all of these reasons I strongly suggest that these medicines be avoided after a gastric bypass operation.
When I tell people this at the Fresh Start Seminar they frequently ask what other suggestions do I have to help them with their joint and back pain. First, I tell them that most people will not need these medications after they lose their weight from bariatric surgery. This of course will decrease the weight on their joints and relieve much of the pressure. Usually our patient lose about 60 lbs in the first three months after bariatric surgery so the feel much better shortly after their operation. Secondly that have access to pain medicine after surgery such as Percocet or Vicodin for a little while. Sometimes I will suggest Ultracet or extra strength Tylenol. Occasionally someone will need to be on a Fentanyl patch for a few weeks or see a sports medicine doctor or orthopedist for a steroid injection. Finally, if the pain is too limiting for them I will agree to place then of Celebrex at about 3 months after their operation but they are informed there is still a risk of these problems even with Celebrex.
I am sure that other bariatric surgeons may feel differently about these matters but this is how I have chosen to instruct our patients and I find that it keeps them from having problems after their operation in they follow these directions.
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