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Surgical Procedures for Peptic Ulcer Disease

Now that doctors understand the connection between Helicobacter pylori infection, nonsteroidal drug usage, and peptic ulcers, ulcer surgery has become quite rare. Most ulcers can be managed and prevented from recurring by testing for and treating H. pylori infection, eliminating nonsteroidal use, and using powerful ulcer healing drugs, such as proton pump inhibitors. However, you may require surgery if, despite several courses of treatment, you still have recurrences or if you have severe complications. Complications that might require surgery include:

  • Bleeding
  • Perforation—Intestinal contents enter into the abdominal cavity. This can lead to a serious infection called peritonitis. Intestinal perforation is a surgical emergency.
  • Obstruction—Scarring from peptic ulcers may obstruct flow through the stomach and duodenum. This is a medical emergency.

Endoscopic Ulcer Treatment

Upper gastrointestinal endoscopy is used to stop bleeding. A lighted scope is passed into the intestinal tract. Bleeding areas can be seen and treated. Heat or electricity applied to the area of bleeding usually stops the blood flow. Epinephrine can also be applied through the endoscope to help stop bleeding. Clips can also be placed on bleeding ulcers to pinch off bleeding blood vessels.

Vagotomy

Vagotomy involves cutting branches of the vagus nerve, which is involved in the production of stomach acid. Cutting the vagus nerve can greatly reduce acid production. Cutting through the entire nerve, however, can interfere with the stomach’s ability to empty itself, so newer techniques cut only part of the nerve.

Antrectomy    TOP

Antrectomy is a surgical procedure whereby the lower part of the stomach (antrum) is removed. The antrum produces a chemical that prompts acid production. Without that chemical, acid production drops. This may provide some protection against recurrent peptic ulcers.

Pyloroplasty    TOP

Pyloroplasty makes the opening between the stomach and the duodenum larger, allowing stomach contents to flow more easily into the intestine. Pyloroplasty was at one time frequently utilized to reduce complications of vagotomy.

References:

Meurer LN, Bower DJ. Management of Helicobacter pylori infection. Am Fam Physician. 2002;65(7):1327-36.
Peptic ulcer disease. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated May 11, 2015. Accessed January 12, 2017.
Last reviewed December 2016 by Daus Mahnke, MD
Last Updated: 5/20/2015

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