A Vagotomy Might Help This Common (but Serious) Stomach Condition

A wave of pain engulfs you as you clutch your stomach. What’s going on? Is it appendicitis? Food poisoning?

It could be a peptic ulcer. Peptic ulcers are open sores in the stomach or small intestines that are further irritated by stomach acid. They are painful, and if left untreated can eat a hole in your stomach, obstruct your bowels or cause internal bleeding.

Luckily, most peptic ulcers can be treated without surgery. But what about the biggest, most painful, hardest-to-stop ulcers? For these ulcers, or those that cause complications, you may have to shut off stomach acid at its source: the vagus nerve. That means you may need a vagotomy.

What Is a Peptic Ulcer?

Peptic ulcers, or stomach ulcers, are open sores that form on the interior lining of your stomach (gastric ulcers) and upper portion of the small intestine (duodenal ulcers). Infection with the bacterium Helicobacter pylori (H. pylori) and continued use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers.

Peptic Ulcer Causes and Incidence

Peptic ulcer disease (PUD) is a common condition affecting approximately 4.5 million people per year, with 10 percent of the U.S. population experiencing a duodenal ulcer at some point in their lifetime. The rate jumps to 20 percent in those with H. pylori infection. The incidence of these ulcers increases with age due to increased use of aspirin and other NSAIDs – a leading cause of peptic ulcers – as well as a rise in the rate of H. pylori infection as we age. Women and men are equally affected.

Peptic Ulcer Risk Factors

Besides the presence of H. pylori and increased use of certain medications, the following are risk factors for developing a peptic ulcer:

  • Smoking
  • Alcohol consumption
  • Weight loss surgery, especially gastric bypass

On their own, none of these risk factors are a cause of an ulcer; however, in conjunction with H. pylori infection and medications, they increase the risk of developing an ulcer. These risk factors also make peptic ulcer symptoms worse and inhibit their ability to heal. Contrary to popular belief, stress and spicy foods do not cause peptic ulcers but they can make symptoms worse.

Peptic Ulcer Symptoms

Peptic ulcer symptoms include:

  • Burning stomach pain (most common)
  • Heartburn
  • Nausea
  • Full feeling
  • Bloating
  • Belching
  • Intolerance of fatty foods

While nearly 75 percent of people with peptic ulcers have no symptoms, a few have severe symptoms, including:

  • Vomiting or vomiting red or black blood
  • Black, tarry stools
  • Dark blood in stools
  • Faintness
  • Trouble breathing
  • Unexplained weight loss
  • Changes in appetite

Peptic Ulcer Diagnosis

If you have symptoms of a peptic ulcer or suspect you may have a peptic ulcer, your doctor will take a medical history, perform a physical exam and order diagnostic tests, which may include:

  • Laboratory tests to detect the presence of pylori may be ordered, using blood, stool or a breath test.
  • An endoscopy may be ordered to see inside your esophagus, stomach and small intestine. The doctor uses a scope inserted through your upper gastrointestinal system to look for ulcers.
  • Finally, an “upper GI series” may be ordered. This series of x-rays is also called a barium swallow. During the x-ray, you will be asked to swallow a liquid that contains barium, which coats your digestive tract, making any ulcers more visible.

Peptic Ulcer Treatment

Once PUD has been diagnosed, treatment will vary depending on the cause of the ulcer, usually starting with medications to kill off H. pylori, eliminating or reducing use of NSAIDs, and using other medication to help the ulcer heal, such as proton pump inhibitors (PPIs) or histamine blockers to reduce acid production, , antacids and cytoprotective agents. Lifestyle changes are also prescribed. These treatments are successful for most people with PUD.

Some PUD sufferers experience persistent, treatment-resistant ulcers. Peptic ulcers that fail to heal are called refractory ulcers. Different antibiotics and home remedies may be tried first along with the first-line of treatments. However, treatment for refractory ulcers and serious ulcer complications, such as acute bleeding or a perforation (tear), may require surgery.

Vagotomy for Peptic Ulcers

A vagotomy is a surgical procedure in which the vagus nerve is severed. Among its other functions, the vagus nerve influences the production of stomach acid. Vagotomies have been performed for decades and have a proven track record for effective treatment of peptic ulcers.

Though not the first line treatment for PUD, vagotomies are required when other first line treatment options have failed. The vagotomy procedure has a high success rate and provides a permanent solution to stubborn ulcers resistant to all other therapies.

Using video-assisted thoracic surgery (VATS), surgeons are able to sever the main trunks of the vagus nerve safely and effectively using a minimally invasive approach. A VATS vagotomy allows for a shorter recovery and hospital stay of just one to two days. The peptic ulcer symptoms resolve very quickly after the procedure, and most patients return to normal activity within a couple weeks.

If you have a stomach ulcer that won’t heal despite medical treatment and lifestyle changes, request an appointment today to discuss this alternative treatment option and see if a vagotomy is an option for you.