What causes peptic ulcers? How are they diagnosed? What are the surgical treatment options for peptic ulcers that don’t respond to medication? Get the answers to these questions and more.

Peptic Ulcers: An Overview

A peptic ulcer is an open sore that develops in the lining of the stomach or the upper part of the small intestine, known as the duodenum. These ulcers occur when the acids that aid in food digestion damage these areas. Research has shown that the most common cause of peptic ulcers is infection with the Helicobacter pylori (H. pylori) bacterium. The long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen can also contribute to the development of peptic ulcers.

Diagnosing Peptic Ulcers

Because the cause of the peptic ulcer determines the appropriate treatment, it is crucial for patients to undergo a comprehensive evaluation. The general and gastrointestinal surgeons at Brigham and Women’s Hospital offer a range of procedures to diagnose peptic ulcers and test for the presence of the H. pylori bacterium:

• Upper GI (gastrointestinal) series (also called barium swallow)
• Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
• Blood, breath, and stomach tissue tests to detect the presence of H. pylori

Complications of Untreated Peptic Ulcers

It is important to seek treatment for peptic ulcers, as complications can arise if left untreated. These complications may include:

• Bleeding
• Stomach or duodenum perforation
• Peritonitis (inflammation of the abdominal lining)
• Obstruction

Non-Surgical Treatment for Peptic Ulcers

Most people with peptic ulcers can benefit from dietary and lifestyle changes, as well as medication:

Diet and Lifestyle Changes

• Avoid foods that cause irritation
• Quit smoking, as it can delay ulcer healing and increase the risk of recurrence
• Reduce alcohol consumption
• Limit the use of anti-inflammatory medications

Medications

• Antibiotics to kill the H. pylori bacterium, if present
• H2-blockers to reduce stomach acid production
• Acid pump inhibitors to block stomach acid production
• Mucosal protective agents to shield the stomach’s lining from acid damage

Surgical Treatment for Peptic Ulcers

For people who do not respond to medication or have experienced complications such as hemorrhage, perforation, or obstruction, surgery is the best option. Brigham and Women’s Hospital surgeons offer extensive expertise in all surgical approaches to treat peptic ulcers:

Gastrectomy and Partial Gastrectomy

These procedures involve removing part or all of the stomach to reduce acid production and prevent further ulceration.

Vagotomy

This procedure involves cutting the vagus nerve to reduce acid secretion.

Antrectomy

This procedure removes the lower part of the stomach, which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes, an adjacent part of the stomach that secretes pepsin and acid may also be removed.

Pyloroplasty

This procedure may be performed in conjunction with a vagotomy to enlarge the opening into the duodenum and small intestine, enabling the contents to pass more easily from the stomach.

Laparoscopic Surgery

Laparoscopic surgery uses a long, thin tube with a camera lens attached to examine the organs inside the abdominal cavity and operate through small incisions, which can lead to faster recovery times for patients.

What to Expect During Treatment

Patients with peptic ulcers will receive a thorough diagnostic examination to evaluate the presence of an ulcer and determine the appropriate course of treatment. If surgery is recommended, patients will likely be scheduled for a pre-operative visit to the Weiner Center for Preoperative Evaluation, where they will receive information and any necessary tests. On the day of the surgery, the patient will be cared for by a team of specialists, including surgeons, anesthesiologists, and nurses. After the surgery, the patient will be transferred to the post-surgical care unit, where they will receive comprehensive care from an experienced surgical and nursing staff.

The Importance of Seeking Treatment

Peptic ulcers should not be left untreated, as complications can arise that may require more invasive surgical intervention. By seeking prompt treatment, either through lifestyle changes, medication, or surgery, patients can effectively manage their peptic ulcers and avoid the potential for more serious health issues.

Peptic Ulcers – Brigham and Women’s Hospital

A peptic ulcer is an open sore in the lining of your stomach or duodenum, the upper part of the small intestine. When the peptic ulcer is in the stomach, it is called a gastric ulcer. When the peptic ulcer is in the duodenum, it is called a duodenal ulcer. Peptic ulcers occur when acids that aid in food digestion damage these areas. Research has shown that infection with Helicobacter pylori (H. pylori) bacterium is the most common cause of peptic ulcers. The long-term use of nonsteroidal anti-inflammatory medicines (NSAIDs) such as aspirin and ibuprofen also contributes. Stress and spicy foods cannot cause peptic ulcers but can aggravate them. Learn more about the risks and causes of peptic ulcers.

At Brigham and Women’s Hospital (BWH), our board certified general and gastrointestinal surgeons offer innovative and effective treatment for patients who have peptic ulcers that do not heal with medication or have caused complications. We perform the latest and most effective minimally invasive surgery to diagnose and treat gastric and duodenal ulcers, including laparoscopic partial gastrectomy, vagotomy, antrectomy and pyloroplasty.

Diagnosis of Peptic Ulcers

Because the cause of the peptic ulcer determines the treatment, it is important that patients receive a comprehensive evaluation. General and gastrointestinal surgeons at Brigham and Women’s Hospital offer a range of procedures for diagnosing peptic ulcers and testing for the H. pylori bacterium:

• Upper GI (gastrointestinal) series (also called barium swallow)
• Esophagogastroduodenoscopy (also called EGD or upper endoscopy)
• Blood, breath and stomach tissue tests detect the presence of H. pylori, a bacterium that causes chronic inflammation of the inner lining of the stomach.

It is important to seek treatment for peptic ulcers because complications, including bleeding, stomach or duodenum perforation, peritonitis and obstruction, can result.

Treatment for Peptic Ulcers

Peptic ulcers typically heal with medication and lifestyle changes. For people who do not respond to medication or have experienced complications such as hemorrhage, perforation or obstruction, surgery is the best option.

Surgical Treatment

Brigham and Women’s Hospital surgeons offer extensive expertise in all surgical approaches:

• Gastrectomy, subtotal or partial gastrectomy, removes part of the stomach.
• Vagotomy involves cutting the vagus nerve to reduce acid secretion.
• Antrectomy removes the lower part of the stomach which produces a hormone that stimulates the stomach to secrete digestive juices. Sometimes, an adjacent part of the stomach that secretes pepsin and acid may be removed. A vagotomy is usually done along with an antrectomy.
• Pyloroplasty may be performed with a vagotomy. In pyloroplasty, the opening into the duodenum and small intestine are enlarged, enabling contents to pass from the stomach.
• Laparoscopic surgery uses a long, thin tube with a camera lens attached to examine the organs inside the abdominal cavity to check for abnormalities, and to operate through small incisions.

Non-Surgical Treatment

Most people with peptic ulcers benefit from dietary and lifestyle changes and medication:

• Diet and lifestyle changes
  • No known diet has been proven to help reduce ulcers, but people should avoid foods that cause irritation.
  • Smoking has been shown to delay ulcer healing and has been linked to recurrence. Quitting smoking is advised.
  • Reduce alcohol consumption.
  • Limit use of anti-inflammatory medications.
• Medications
  • Antibiotics to kill H. pylori if it has been detected.
  • h3-blockers to reduce acid the stomach produces by blocking histamine.
  • Acid pump inhibitors help to block stomach acid production by stopping the stomach’s acid pump.
  • Mucosal protective agents shield the stomach’s mucous lining from the damage of acid, but do not inhibit the release of acid.
  • When treating H. pylori, these medications are often used in combination.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have a peptic ulcer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced general and gastrointestinal surgeon are important to the successful outcome for patients with peptic ulcers and stomach conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with gallstones or bile duct stones. After surgery you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating peptic ulcers and stomach conditions. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

General and Gastrointestinal Surgery Appointments and Locations

• Our General and Gastrointestinal Surgery Team
• Request General and Gastrointestinal Surgery Appointment
• General and Gastrointestinal Surgery Locations

Resources

Go to our health library to learn more about peptic ulcers.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

Emergency Ulcer Surgery – PMC

1. Paimela H, Paimela L, Myllykangas-Luosujarvi R, et al. Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scandinavian Journal of Gastroenterology. 2002;37(4):399–403. [PubMed] [Google Scholar]

2. Schwesinger WH, Page CP, Sirinek KR, et al. Operations for peptic ulcer disease: paradigm lost. Journal of Gastrointestinal Surgery. 2001;5(4):438–443. [PubMed] [Google Scholar]

3. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51–58. [PubMed] [Google Scholar]

4. Sarosi GA, Jr, Jaiswal KR, Nwariaku FE, et al. Surgical therapy of peptic ulcers in the 21st century: more common than you think. Am J Surg. 2005;190(5):775–779. [PubMed] [Google Scholar]

5. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374(9699):1449–1461. [PubMed] [Google Scholar]

6. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1(8390):1311–1315. [PubMed] [Google Scholar]

7. NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. JAMA. 1994;272(1):65–69. [PubMed] [Google Scholar]

8. Wallace JL. Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn’t the stomach digest itself? Physiol Rev. 2008;88(4):1547–1565. [PubMed] [Google Scholar]

9. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002;359(9300):14–22. [PubMed] [Google Scholar]

10. Ahsberg K, Ye W, Lu Y, et al. Hospitalisation of and mortality from bleeding peptic ulcer in Sweden: a nationwide time-trend analysis. Aliment Pharmacol Ther. 2011;33(5):578–584. [PubMed] [Google Scholar]

11. Groenen MJ, Kuipers EJ, Hansen BE, et al. Incidence of duodenal ulcers and gastric ulcers in a Western population: back to where it started. Can J Gastroenterol. 2009;23(9):604–608. [PMC free article] [PubMed] [Google Scholar]

12. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–113. [PubMed] [Google Scholar]

13. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–1321. [PubMed] [Google Scholar]

14. Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70(2):212–224. [PubMed] [Google Scholar]

15. Cook DJ, Guyatt GH, Salena BJ, et al. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology. 1992;102(1):139–148. [PubMed] [Google Scholar]

16. Sacks HS, Chalmers TC, Blum AL, et al. Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA. 1990;264(4):494–499. [PubMed] [Google Scholar]

17. Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009;7(1):33–47. quiz 31–32. [PubMed] [Google Scholar]

18. Rockall TA, Logan RF, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38(3):316–321. [PMC free article] [PubMed] [Google Scholar]

19. Elmunzer BJ, Young SD, Inadomi JM, et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008;103(10):2625–2632. quiz 2633. [PubMed] [Google Scholar]

20. Morris DL, Hawker PC, Brearley S, et al. Optimal timing of operation for bleeding peptic ulcer: prospective randomised trial. Br Med J (Clin Res Ed) 1984;288(6426):1277–1280. [PMC free article] [PubMed] [Google Scholar]

21. Saperas E, Pique JM, Perez Ayuso R, et al. Conservative management of bleeding duodenal ulcer without a visible vessel: prospective randomized trial. Br J Surg. 1987;74(9):784–786. [PubMed] [Google Scholar]

22. Imhof M, Ohmann C, Roher HD, et al. Endoscopic versus operative treatment in high-risk ulcer bleeding patients – results of a randomised study. Langenbecks Arch Surg. 2003;387(9–10):327–336. [PubMed] [Google Scholar]

23. Lau JY, Sung JJ, Lam YH, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med. 1999;340(10):751–756. [PubMed] [Google Scholar]

24. Hopper AN, Stephens MR, Lewis WG, et al. Relative value of repeat gastric ulcer surveillance gastroscopy in diagnosing gastric cancer. Gastric Cancer. 2006;9(3):217–222. [PubMed] [Google Scholar]

25. Csendes A, Braghetto I, Calvo F, et al. Surgical treatment of high gastric ulcer. Am J Surg. 1985;149(6):765–770. [PubMed] [Google Scholar]

26. Ng EK, Lam YH, Sung JJ, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Annals of Surgery. 2000;231(2):153–158. [PMC free article] [PubMed] [Google Scholar]

27. Gilliam AD, Speake WJ, Lobo DN, et al. Current practice of emergency vagotomy and Helicobacter pylori eradication for complicated peptic ulcer in the United Kingdom. British Journal of Surgery. 2003;90(1):88–90. [PubMed] [Google Scholar]

28. Millat B, Hay JM, Valleur P, et al. Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research. World J Surg. 1993;17(5):568–573. discussion 574. [PubMed] [Google Scholar]

29. Poxon VA, Keighley MR, Dykes PW, et al. Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial. Br J Surg. 1991;78(11):1344–1345. [PubMed] [Google Scholar]

30. Eriksson LG, Ljungdahl M, Sundbom M, et al. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19(10):1413–1418. [PubMed] [Google Scholar]

31. Holme JB, Nielsen DT, Funch-Jensen P, et al. Transcatheter arterial embolization in patients with bleeding duodenal ulcer: an alternative to surgery. Acta Radiol. 2006;47(3):244–247. [PubMed] [Google Scholar]

32. Bertleff MJ, Lange JF. Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature Surg Endosc. 2010;24(6):1231–1239. [PMC free article] [PubMed] [Google Scholar]

33. Lanas A, Serrano P, Bajador E, et al. Evidence of aspirin use in both upper and lower gastrointestinal perforation. Gastroenterology. 1997;112(3):683–689. [PubMed] [Google Scholar]

34. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991;115(10):787–796. [PubMed] [Google Scholar]

35. Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998;93(11):2037–2046. [PubMed] [Google Scholar]

36. Mort JR, Aparasu RR, Baer RK. Interaction between selective serotonin reuptake inhibitors and nonsteroidal antiinflammatory drugs: review of the literature. Pharmacotherapy. 2006;26(9):1307–1313. [PubMed] [Google Scholar]

37. Graham DY, Malaty HM. Alendronate and naproxen are synergistic for development of gastric ulcers. Arch Intern Med. 2001;161(1):107–110. [PubMed] [Google Scholar]

38. Silen W. Cope’s early diagnosis of the acute abdomen. 19. New York: Oxford University Press; 1996. [Google Scholar]

39. Svanes C, Lie RT, Svanes K, et al. Adverse effects of delayed treatment for perforated peptic ulcer. Ann Surg. 1994;220(2):168–175. [PMC free article] [PubMed] [Google Scholar]

40. Boey J, Wong J, Ong GB. A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg. 1982;195(3):265–269. [PMC free article] [PubMed] [Google Scholar]

41. Grassi R, Romano S, Pinto A, et al. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50(1):30–36. [PubMed] [Google Scholar]

42. Lew E. Peptic Ulcer Disease. In: Greenberger NRB, Burakoff R, editors. Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. 1. Columbus: McGraw-Hill; 2009. pp. 175–183. [Google Scholar]

43. Gisbert JP, de la Morena F, Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(8):1921–1930. [PubMed] [Google Scholar]

44. Leodolter A, Wolle K, Peitz U, et al. Evaluation of a near-patient fecal antigen test for the assessment of Helicobacter pylori status. Diagn Microbiol Infect Dis. 2004;48(2):145–147. [PubMed] [Google Scholar]

45. Lee SC, Fung CP, Chen HY, et al. Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect Dis. 2002;44(1):23–27. [PubMed] [Google Scholar]

46. Shan YS, Hsu HP, Hsieh YH, et al. Significance of intraoperative peritoneal culture of fungus in perforated peptic ulcer. Br J Surg. 2003;90(10):1215–1219. [PubMed] [Google Scholar]

47. Donovan AJ, Berne TV, Donovan JA. Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg. 1998;133(11):1166–1171. [PubMed] [Google Scholar]

48. Crofts TJ, Park KG, Steele RJ, et al. A randomized trial of nonoperative treatment for perforated peptic ulcer. N Engl J Med. 1989;320(15):970–973. [PubMed] [Google Scholar]

49. Moller MH, Shah K, Bendix J, et al. Risk factors in patients surgically treated for peptic ulcer perforation. Scand J Gastroenterol. 2009;44(2):145–152. 142. following 152. [PubMed] [Google Scholar]

50. Cellan-Jones CJ. A Rapid Method of Treatment in Perforated Duodenal Ulcer. Br Med J. 1929;1(3571):1076–1077. [PMC free article] [PubMed] [Google Scholar]

51. Siu WT, Leong HT, Law BK, et al. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002;235(3):313–319. [PMC free article] [PubMed] [Google Scholar]

52. Ng EK, Lam YH, Sung JJ, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000;231(2):153–158. [PMC free article] [PubMed] [Google Scholar]

53. Johnson AG. Proximal gastric vagotomy: does it have a place in the future management of peptic ulcer? World J Surg. 2000;24(3):259–263. [PubMed] [Google Scholar]

54. Lehnert T, Buhl K, Dueck M, et al. Two-stage radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol. 2000;26(8):780–784. [PubMed] [Google Scholar]

55. McGee GS, Sawyers JL. Perforated gastric ulcers. A plea for management by primary gastric resection. Arch Surg. 1987;122(5):555–561. [PubMed] [Google Scholar]

56. Jani K, Saxena AK, Vaghasia R. Omental plugging for large-sized duodenal peptic perforations: A prospective randomized study of 100 patients. South Med J. 2006;99(5):467–471. [PubMed] [Google Scholar]

57. Lal P, Vindal A, Hadke NS. Controlled tube duodenostomy in the management of giant duodenal ulcer perforation: a new technique for a surgically challenging condition. Am J Surg. 2009;198(3):319–323. [PubMed] [Google Scholar]

58. Gupta S, Kaushik R, Sharma R, et al. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15. [PMC free article] [PubMed] [Google Scholar]

Surgical treatment of gastric and duodenal ulcers

Indications for surgical treatment are divided into absolute, conditionally absolute and relative.

Absolute indications for surgical treatment of peptic ulcer are

• ulcer perforation
• profuse or recurrent gastroduodenal bleeding
• pyloroduodenal walls oz and gross cicatricial deformities of the stomach, accompanied by violations of its evacuation function
• callous and penetrating gastric ulcers that do not heal with adequate conservative treatment for 3-4 months
• ulcer recurrence after previous suturing of a perforated ulcer

Relative indications 9 0004 to the surgical treatment of peptic ulcer is the failure of a full-fledged conservative treatment, namely :

• frequently recurring ulcers not responding well to repeated courses of conservative therapy
• (resistant) ulcers that do not heal for a long time despite conservative treatment, accompanied by severe clinical symptoms (pain, vomiting, hidden bleeding)
• multiple ulcers with high acidity of gastric juice treatment or the patient himself expresses a desire to get rid of peptic ulcer surgically
• intolerance to the components of drug therapy.

Operations for peptic ulcer

Modern elective vagotomy operations do not incapacitate patients, as previously widely used gastric resections, their lethality is less than 0.3%. Timely vagotomy, in addition to guaranteed recovery of the patient, saves his personal and state funds, improves the quality of life.

The best operation for duodenal ulcer is selective proximal vagotomy. It consists in the intersection of the small branches of the gastric nerve of Latarje, innervating the body and fornix of the stomach, where acid-producing parietal cells are located. The distal branches of the Latarjet nerve, which innervate the antrum and the pylorus, are preserved during this operation, which ensures the physiological motility of the antrum and the full evacuation of the contents. In the absence of organic pyloroduodenal stenosis, there is no need for an operation draining the stomach.

In case of persistent cicatricial narrowing of the bulb or pylorus, an operation is indicated that shunts the stenotic canal or expands its diameter (duodenoplasty or gastroduodenostomy).

Currently, selective proximal vagotomy without pyloroplasty is a standard operation in the treatment of duodenal ulcers that cannot be permanently cured, including ulcers with a history of complications. Peptic ulcer recurrence is observed in 2-12% of patients, which is associated with inadequate or incomplete vagotomy.

Surgical treatment of gastric ulcer is performed according to the same indications as in the treatment of duodenal ulcer. However, the terms of conservative treatment for gastric ulcers should be reduced the more confidently, the larger the size and number of ulcers, the deeper the niche, the older the patient, the longer the history of the disease and the more often its relapses. Doubtful, indefinite data of histological examination of biopsy specimens from the edges of the ulcer can also serve as an additional argument in favor of surgical treatment.

The operation of choice for gastric ulcer , given the risk of a previously unidentified cancerous ulcer, is resection of the stomach , better according to Billroth I . The advantage of resection of the stomach according to Billroth-I is the preservation of the physiological passage of food through the duodenum.

Surgery for gastric and duodenal ulcer

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Indications Contraindications Preparation Features of the technique Rehabilitation

With the development of the pharmaceutical industry, this technique is used quite rarely, and preference is given to drug treatment methods. However, with their ineffectiveness, extensive bleeding, or when the ulcer is perforated, surgery is indicated.

Main indications for surgery

• failure of drug treatment, that is, non-healing of the ulcer, twice a year or more – relapses of ulcers, early relapses after taking drugs;
• severe ulcerative pain that limits the ability to work and does not go away despite drug therapy;
• complicated ulcer – bleeding, perforation, narrowing of the pylorus.

Indications for resection of the stomach:

• multiple ulcers, one of which is perforated and the other bleeding;
• extensive callous ulcers of the stomach;
• at the same time stomach and duodenal ulcer.

Contraindications for surgery

Absolute contraindications:

• hemorrhagic shock;
• heart disease with severe circulatory failure;
• purulent peritonitis;
• numerous operations on the abdominal organs;
• lung diseases with respiratory failure;
• blood clotting disorder.

Relative contraindications:

• local diffuse peritonitis;
• diaphragmatic hernia;
• severe obesity;
• advanced cancer of the gastrointestinal tract;
• contraindications to general anesthesia.

Preparing for surgery

The patient must undergo endoscopic diagnosis as prescribed by the physician, as well as standard preoperative preparation, which includes:

• clinical and biochemical blood tests;
• blood tests for HIV, syphilis, hepatitis B and C;
• coagulogram;
• urinalysis;
• fluorography;
• ECG.

With the results of the examination, it is necessary to visit a general practitioner who, in the absence of contraindications, signs the authorization for the operation. After that, it is necessary to consult with an anesthesiologist and a surgeon.

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Method features

Surgical treatment of this disease is carried out by several methods:

• Vagotomy. This is the intersection of the branches of the nerve that stimulates the production of hydrochloric acid in the stomach. After such an operation, the acidity in the stomach decreases, the tissues heal on their own.
• Removal of part of the stomach according to the Blroth methods I and II, as well as their modifications. During the operation, a part of the mucous membrane is removed, which intensively produces enzymes and hydrochloric acid. It can be carried out with perforation of the ulcer and other complications, provided that the patient’s condition allows it.
• Pyloroplasty. This is a technique for treating peptic ulcer of both the stomach and duodenum with narrowing of the duodenal bulb and pylorus.

In some cases, laparoscopic gastrectomy is performed without large external incisions. Such an operation is carried out with complications. If the patient is in serious condition, then the perforated ulcer is simply sutured and the abdominal cavity is drained.

Operations can be scheduled and urgent. Emergency intervention is indicated for bleeding that is not stopped by drugs, and perforation of the ulcer. In these cases, the ulcer is sutured, the narrowed digestive tube expands, and bleeding stops.

Surgical treatment is also carried out in case of malignancy (malignancy) of the ulcer. Its success depends on how early the tumor is detected, whether it has affected only the mucous and submucosal layers or has grown into all layers of the stomach, whether nearby organs, lymph nodes are affected, and whether there are distant metastases.

Possible complications after surgery

Here are the statistics on possible complications:

• 16% – suture divergence;
• 11% of cases – intestinal obstruction;
• 8% – violation of evacuation;
• 6% – peritonitis;
• 5% difficulty in swallowing;
• 4% – bleeding into the lumen of the stomach or into the abdominal cavity;
• 3% – infiltrates;
• 3% – suppuration and abscesses.

It is difficult to prevent these consequences, because much depends on the professionalism of the surgeon and the general condition of the patient’s body. The most dangerous complications are internal bleeding and peritonitis, because even death is likely. If the seams have parted, suppuration or infiltrates have appeared, the operation is repeated. Difficulties in swallowing and impaired evacuation can be relieved by taking certain medications.

Rehabilitation after surgery

Rehabilitation should include three main aspects:

• early activation of the patient;
• therapeutic and breathing exercises;
• special diet.

All this prevents complications and accelerates tissue repair processes.

Passive and active leg movements are allowed on the first day after the operation. From the very first day you need to do breathing exercises. In the absence of contraindications, already on the 2-3rd day you can get out of bed.

If the recovery is going well, the stitches will be removed on the 8th day. Usually, after 2 weeks, the patient is already discharged from the hospital if there are no complications and rehabilitation is going well.

Diet after peptic ulcer surgery

A very strict diet must be observed in the postoperative period.

If the operation was not severe and without complications, then from the second day you can drink water – 0.5 cups a day with teaspoons. From the third day, you can already drink 0.5 liters, in addition to water, strong tea and broth are added. From the fourth day, you can drink 4 glasses a day, which must be divided into 8-12 doses. As food, you can eat jelly, raw eggs, yogurt, mucous soups, sour cream.

From the fifth day, depending on the patient’s condition, liquid food can be consumed in unlimited quantities. Grated soups, cottage cheese, semolina are allowed. From the seventh day, well-ground boiled meat can be included in the diet. Approximately from the 9th day, the patient switches to diet No. 1a, that is, an anti-ulcer table, with the exception of dishes that are prepared with whole milk. Nutrition should be fractional – 7 times a day in very small portions.

Prevention of relapse

First of all, it is necessary to exclude the factors that cause peptic ulcer:

• alcohol consumption;
• stresses;
• smoking;
• strenuous exercise;
• wrong diet, eating fried, spicy food, smoked meats, fast food;
• non-compliance with the diet.

To prevent ulcers you need:

• sleep at least 6-8 hours a day;
• minimize the consumption of food that irritates the gastric mucosa – fatty, smoked, fried;
• chew food well;
• eat up to 6 times a day;
• eat chopped food, cereals, kissels, omelettes, vegetables, steamed meat;
• see a doctor immediately if you have stomach pain;
• avoid alcohol and smoking;
• protect yourself from stress;
• Minimize your coffee intake;
• eat boiled, baked, steam food with a minimum of spices.

It is necessary to visit a doctor for preventive examinations once a year. Also, for prevention, all patients are prescribed courses of antiulcer drugs in summer and spring.

Popular questions

Surgery in the presence of a stomach ulcer occurs in situations where ulcerative defects do not heal for a long time, complications arise that threaten life and health. Intervention can be planned or emergency. According to emergency indications, a perforated ulcer is sutured, bleeding stops, and the lumen of the digestive tube expands.

If signs of malignancy are found in gastric ulcer, surgical treatment is prescribed in a planned manner. The volume of removal depends on the stage of the tumor. The operation can be performed both classically and endoscopically, laparoscopically.

In the first days and weeks after the operation on the background of gastric ulcer, the most sparing diet is necessary. Table number 1 is recommended, which includes pureed, thermally and chemically processed dishes. You can use mashed soups, mashed potatoes, vegetables, meat dishes that are steamed, carefully cooked. Dried white bread, jelly, dairy products are allowed.

Juice and irritating foods, those that provoke bloating and fermentation, are excluded from the diet. Exclude cabbage, garlic and onions, spices and seasonings, peppers, fast food, radishes, mushrooms, sorrel. Also excluded are concentrated broths, legumes, rich pastries, sour fruits, tomatoes, millet.

Specialists in this field 30 doctors

Leading doctors 4 doctors

Senko Vladimir Vladimirovich

Head of the Center for Surgery and Oncology

Work experience: 23 years

Dunaisky, 47

Dunayskaya metro station

Marshala Zakharov, 20

Leninskiy pr-t metro station

Vyborgskoe shosse, 17

Prosveshcheniya metro station 9 0005

Make an appointment

Krikunov Dmitry Yurievich

Surgeon

Work experience: 8 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Salimov Vakhob Valiyevich

Surgeon, oncologist

9000 6 Work experience: 13 years

Vyborgskoe shosse, 17

m. Prosveshcheniya

Dybenko, 13k4

m.

Surgeon, oncologist, mammologist, endocrine surgeon

Work experience: 22 years

Udarnikov, 19

metro station Ladozhskaya

marshala Zakharov, 20

metro station Leninsky pr-t

Vyborgskoye highway, 17

metro station Prosveshcheniya

9 0006 Make an appointment

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+26 doctors

Other doctors 26 doctors

Aramyan David Surenovich

Surgeon, coloproctologist, oncologist, mammologist

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

9 0002
Bogushevich Irina Gennadievna

Oncologist, mammologist, pediatric surgeon

Work experience: 10 years

Vyborg highway, 17

m. Prosveshcheniya

Make an appointment

Grinevich Vladimir Stanislavovich

Surgeon, oncologist, mammologist, coloproctologist

Work experience: 27 years

Vyborgskoe shosse, 17

m.
Dubskikh Natalya Aleksandrovna

Surgeon

Work experience: 5 years0006 Make an appointment

Karapetyan Zaven Surenovich

Coloproctologist, surgeon and phlebologist

Work experience: 15 years

Dunaysky, 47

Dunayskaya metro station

Marshal Zakharov, 20

900 06 metro station Leninsky pr-t

Make an appointment

Klyuev Andrey Nikolaevich

Operating proctologist

Work experience: 16 years

Malaya Balkanskaya, 23

m. Kupchino

Make an appointment

Kolosovsky Yaroslav Viktorovich

Surgeon, mammologist, oncologist

Work experience: 17 years

Dybenko, 13k4

m. Dybenko street

Make an appointment

9 0002
Lopatin Ivan Mikhailovich

Operating surgeon

Work experience: 5 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Maslennikov Dmitry Yurievich

Surgeon, proctologist, mammologist

Work experience: 16 years

Udarnikov, 19

metro Ladozhskaya

Dybenko, 13k4

metro Dy Street benko

Make an appointment

Nekrasov Roman Alexandrovich

Coloproctologist and surgeon

Work experience: 8 years

Udarnikov, 19

Ladozhskaya metro station

Marshala Zakharov, 20

Leninsky pr. -t

Make an appointment

Ogorodnikov Vitaliy Viktorovich

Surgeon

Work experience: 19 years

Vyborgskoe shosse, 17

m.
Osokin Anton Vladimirovich

Surgeon, oncologist, mammologist

Work experience: 19 years

Dunaisky, 47

Dunayskaya metro station

Malaya Balkanskaya, 23

m. Kupchino

Make an appointment

Petrova Vitalina Vasilievna

Operating proctologist

Work experience: 12 years

Vyborgskoe shosse, 17

Prospekt Prosveshcheniya metro station

Make an appointment

Petrushina Marina Borisovna

Surgeon, proctologist

Work experience: 42 years

Udarnikov, 19

Ladozhskaya metro station

Make an appointment

Pfanenshtil Anatoly Viktorovich

Surgeon, mammologist and oncologist. Doctor of the highest category.

Work experience: 15 years

Dunaisky, 47

Dunayskaya metro station

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment 9000 5
Sinyagina (Nazarova) Maria Andreevna

Surgeon, proctologist

Work experience: 8 years

Marshala Zakharova, 20

Leninsky Prospekt

Make an appointment

900 02
Skorokhod Andrey Andreevich

Thoracic surgeon, oncologist. Candidate of Medical Sciences.

Work experience: 9 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Sokolova Anna Sergeevna

Coloproctologist, surgeon. Candidate of Medical Sciences.

Work experience: 13 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Sol Anton Aleksandrovich

Work experience: 15 years

Vyborgskoe highway, 17

metro Prosveshcheniya

Make an appointment

Fomenko Nikolai Aleksandrovich

Surgeon, proctologist, oncologist

Work experience: 15 years

Marshal Zakharova, 20

m. Leninsky pr-t

Sign up for reception

Khangireev Alexander Bakhytovich

Surgeon, oncologist, coloproctologist

Work experience: 13 years

Udarnikov, 19

Ladozhskaya metro station

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Khokhlov Sergey Viktorovich

Surgeon, oncologist, coloproctologist

Work experience: 28 years

Vyborg highway, 17

m. Prospekt Prospection

Sign up for reception

Shishkin Andrey Andreevich

Surgeon, phlebologist, proctologist. Candidate of Medical Sciences

Work experience: 13 years

Dunaisky, 47

Dunayskaya metro station

Make an appointment

Yakovenko Denis Vasilyevich

Surgeon

Work experience: 14 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Yakovenko Taras Vasilyevich

Surgeon, Candidate of Medical Sciences

Work experience: 21 years

Dunaysky, 47

Dunayskaya metro station

Make an appointment

Yalda Ksenia Davidovna

Coloproctologist

Work experience: 11 years

Malaya Balkanskaya, 23

Kupchino metro station

Make an appointment

Hide the list 90 005

Our branches in St. Petersburg

6 branches

Center for Surgery Dunayskaya metro station

47 Dunaisky prospect

Dunaiskaya metro station

daily from 09:00 to 22:00

Surgery Center Ladozhskaya metro station

Udarnikov Avenue, 19/1

Ladozhskaya metro station

daily from 09:00 to 22:00

Center for Surgery Metro station “Leninsky Prospekt”

st.