I saw a patient in the office today who was complaining of epigastric pain.
She had had a gastric bypass operation 6 months ago and had stopped smoking as we required prior to surgery. Unfortunately, she had restarted smoking and now presented to my office with worsening pain in her abdomen just below her breast bone which has continues for two days.
The pain is constant and sometimes is felt into her back. It feels worse when she eats or drinks.
This situation is most consistent with an ulcer that develops at the connection of the gastric pouch to the intestine. We refer to it as a marginal ulcer.
This problem is 40 times more frequent in people who smoke after a gastric bypass. That is why at Fresh Start Bariatrics we require that patients stop smoking prior to surgery and we strongly advise that patients refrain from smoking for the rest of their lives.
When necessary an ulcer is diagnosed with an Upper Endoscopy.
Other causes of a marginal ulcer could include:
• Use of alcohol
• Ingestion of non steroidal anti-inflammatory medications such as ibuprofen or naprosyn
• Infection in the stomach from Heliobactor Pylori
A marginal ulcer is treated for several months by:
• Stop smoking and other possible causes of the ulcer
• Start Sucrafate to bring relief from the pain by coating the ulcer
• Start Omeprazole or another proton pump inhibitor twice daily
• Pain medications as necessary
• Adequate protein in the diet
Potential complications could include:
• Bleeding from the ulcer
• Perforation with leakage of gastric contents into the abdomen requiring an emergency operation
• Scarring that will narrow the gastric outlet and require dilation of the narrowing with a dilation balloon or an operation to remove the ulcer and create a new connection between the gastric pouch and the intestine
The message is clear. Do not smoke if you ave a gastric bypass. If you do smoke you are likely to develop a marginal ulcer.
Then I would suggest that more wisdom lies in quitting smoking than going through excessive pain after the surgery.It is anyway a very bad habit and should be shed as soon as possible.
ReplyDeleteSo I understand not smoking after surgery. Others have been asking me why we can't use a straw or chew gum. Is it because it causes air to get into the new pouch/stomach and makes it expand? I have heard from people who have had the surgery that a few years later they are using straws and chewing gum without problems..so I am a little confused.
ReplyDeleteTo gastric bypass surgery Los Angeles:
ReplyDeleteWe require patients to stop smoking at least 6 weeks before surgery or we will not operate on the patient. (See previous posting re preparation for surgery) Occationally patients will resume smoking against medical advice and this posting addresses this issue. Thanks for reading and leaving a comment.
To Amonymous:
We teach our patients not to chew gum or use a straw after bariatric surgery because these activities result in swallowing more air which results in more rectal gas. I do not believe the extra air will cause enlargement of the gastric pouch. Chewing gum and using a straw will not harm you but may make you alot less popular!
From Dr. Myers 2/25/2011
what about using a electronic cigarette?
ReplyDeleteKeep your fingers busy, you can knit, read, play card/computer games. Alter what you do when you usually smoke, instead of sitting down to have a smoke, get up and shower, take a bath, go for a walk, play a video game, head over to the library, go for a drive.Snacking on carrots and celery helped me a great deal and I held a pencil in my hand for over a week because I felt I needed to have something in my hand since I no longer was holding a cigarette.
ReplyDeleteVery informative post for me as I am always looking for new content that can help me and my knowledge grow better.
ReplyDeleteGr8…Keep it up!!!!
management information system
How long are we supposed to wait to smoke after the gastric bypass surgery ? Let me know the minimum period one has to wait to start smoking again.
ReplyDeleteI had gastric bypass in 2010, i had quit smoking all these years but started again last month. Will i still get ulcers? How long does an ulcer take to develop? Im smoking about 4 or 5 cigarettes a day now.
ReplyDeleteplease could you reply to my earlier questions. I need to know if i had my gastric bypass in 2010 is it ok to smoke now
ReplyDeleteI have had an anastomotic ulcer since surgery +7 years. How long do I take the meds of Sucralfate and Omeprazole. Have taken them since surgery and still need. Very saddened since it is painful when I try to see if it has healed. I do not smoke, nor have I ever smoked to cause the problem.
ReplyDeleteI have been disappointed by the whole procedure and resulting issues which include the ulcer, high blood pressure (not a problem prior to surgery), milk intolerance and food texture revulsion (very difficult if not impossible to get protein in with this).