Ulcers

Question
Hello,

I am post op R&Y 5 and a half years. Right after surgery I developed an ulcer not from the surgery point, but where the esophagus and the stomach meet. Using carafait it went away, now recently I have what we think is another one that has developed, food and liquid feel like it's "stuck" just below the breast bone, i have a lot of regurgitation. Can these ulcers still develop this long after surgery. Prior to surgery, my surgeon takes a blood test to determine if post op patients are prone to ulcers. I am just not understanding what would cause a flare up after such a long time. If anything, I have restructured my eating, back to the basics as I have started gaining weight back, and also seeking group and individual support again. Just curious as to what your thoughts my be on this.

Thank you.

Answer
Kris,
I regret that I have not previously encountered ulcers at the junction of the esophagus and the stomach, neither in person nor in the surgical literature.  Still, I have two thoughts:

1) Perhaps you have a fistula (abnormal connection) between your small stomach pouch and your larger bypassed stomach.  This would allow acid from the bypassed stomach to travel "backwards" to the stomach pouch where it can cause all kinds of trouble.  A fistula can be diagnosed by Upper GI X-ray, Upper scope (egd), or by CT scan with oral contrast.  If a fistula is present, then surgical correction is probably appropriate, though surgically very challenging.

2) Perhaps you have developed a Hiatal Hernia.  (there is a good description of Hiatal Hernia on Wikipedia, http://en.wikipedia.org/wiki/Hiatal_hernia)   If so, the abnormal physical strain on the gastric pouch could cause ulcers and difficulty eating.  It is possible that you have had a Hiatal Hernia for years, and it is just now becoming apparent since you have gained a bit of weight and there is more pressure on the hernia.  Hiatal hernia can be diagnosed by Upper GI X-ray or by egd.  Good news, surgical repair of a Hiatal Hernia is fairly safe and the recovery is not to extensive.

Best of luck!
Dr JP

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