A less common type of ulcer is a peptic ulcer. This is caused by too much stomach acid and pepsin. These may form in the duodenum as well as in the stomach. These days, most peptic ulcers are healed with drugs, but some need surgery. In some cases, an operation is needed because it is not clear whether the ulcer is peptic, or could be malignant.
The aim is to remove any malignant tumour with some or all of the stomach. Some of the oesophagus or duodenum may also need to be removed. This will be to get a clear area of healthy tissue to minimise the chance of the ulcer coming back. The nearby lymph glands need to be removed, to see whether there are any malignant cells in them. If so, drug treatment may be needed in the future.
The main aims of an operation for a peptic ulcer are to stitch up any bleeding artery and to close any burst (perforation). Modern powerful drugs cut down the acid so that the ulcer heals. If the drugs are not working well, an operation can do this. In the operation, we remove the acid controlling, lower, part of the stomach, and not the upper half. Less acid and pepsin is now produced so, the ulcer should heal up, whether it is in the stomach or the duodenum.
You will be asleep with a general anaesthetic during the operation.
The operation will stop any bleeding ulcer, seal any burst ulcer, and remove malignant disease. It should relieve any difficulty swallowing and stop the vomiting.
Are there any alternatives?
Medicines and tablets will not be helpful a malignant tumour. Neither would x-ray or laser treatment.
If there is a blockage to the entrance of the stomach, a special tube can be passed down the oesophagus to hold the narrow part open. This is a good treatment for someone who is not fit enough for an operation.
Sometimes an operation to bypass the diseased part in the stomach is better than removing the stomach. We can only usually decide an alternative like this during the operation.
The vagus nerve controls acid release into the stomach. An operation to cut the vagus nerve to the stomach, called a vagotomy, instead of removing the stomach, would be an alternative in many cases of peptic ulcer. Your specialist can discuss this with you.
What if you do nothing?
Waiting and seeing if the condition will get better is not a good plan. Any troubles you have noticed will get worse. Other serious problems may well appear.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006