Ulcers after Gastric Bypass surgery occur most frequently in patients who continue to smoke after surgery. They can occur in non-smokers as well, but less commonly. Approximately 75% of all Gastric Bypass patients who smoke at any point after surgery will develop ulcers. Also, if you continue to smoke after developing an ulcer, all treatments of the ulcer will fail. Eventually, the ulcer will either begin to bleed or perforate, requiring an emergent surgery.
Ulcers typically cause pain very high up in your abdomen, just underneath your breast bone, particularly with eating. They also cause a significant decrease in your appetite. Patients with significant ulcers will often start to lose weight again several years after surgery. I can often diagnose ulcers in the office within a few seconds of meeting the patient. The smell of tobacco on the patient is my first clue, but what confirms the diagnosis is that the patient looks like they have end stage cancer. Chronic marginal ulcers cause severe malnutrition that results in a sunken face, pale skin and a general appearance of poor health. Occasionally, patients tell me that they do not want to have a gastric bypass performed because they have a friend who had the surgery and now looks terrible. When I ask if this person smokes, the answer is almost always yes.
While ulcers can occur in non-smoking patients, this is rare and they are easier to treat than in smokers. Often times, a one to two month course of treatment with aggressive antacids allows the ulcer to heal, but in rare circumstances, surgery is needed. I’ve found that surgery is very effective in treating ulcers that are resistant to medications if the patient quits smoking first, or never smoked in the first place. Patients that continue to smoke after ulcer surgery will develop another ulcer within a year or two.