Wednesday, March 13, 2013

Ulcers after gastric bypass (the no-no list)

The "don't list" after gastric bypass surgery is pretty long.

Don't drink out of a straw
Don't drink with your meal
Don't drink soda/carbonated beverages
Don't eat sugar/bread
Don't chew gum
Don't drink coffee
Don't take aspirin
Don't drink alcohol
Don't overeat
Don't snack

Blah blah blah

How many of these rules do most of us end up breaking?  Well, today I want to talk about why we shouldn't break a few of these rules especially. 

After gastric bypass surgery, the acid in our stomach is severely reduced, leaving our stomach lining slightly more vulnerable and potentially at a higher risk for ulcers.  Although I have read conflicting reports (shocker, huh) about what actually does and does not cause an ulcer, there are a few items I'd like to specifically discuss today.  There are different types of ulcers.  I won't bore you with a medical lesson (although you can read the Mayo Clinic's list of potential complications HERE, if you're curious).  Let's just talk generalities (especially since everyone is on their own journey). 

NSAIDs (nonsteroidal anti-inflammatory)

Aleve (naproxen), aspirin, Motrin/Advil (ibuprofen) are all no-no's after gastric bypass.  Tylenol (acetaminophen) is really all we are safely supposed to be able to take.  I don't know about you, but Tylenol only fixes my headaches, not my body aches. 


Non-steroidal anti-inflammatory medications (NSAIDs), such as Advil, Motrin, Aleve, Excedrin and Celebrex, are used primarily to treat inflammation, fever and mild to moderate pain from headaches, arthritis, sports injuries and menstrual cramps. Taking NSAIDs after gastric bypass surgery significantly increases the risk of developing marginal ulcers at the connection between the stomach pouch and the Roux limb. Thus, gastric bypass patients should avoid these medications.

Side note: Also a good point from this article, which some patients might not realize, we shouldn't be taking time-release capsules:

The shorter intestinal length after gastric bypass or duodenal switch surgery can make extended-release drug preparations less effective. Some extended-release drugs include antidepressants (Wellbutrin XL), anxiolytics and sleep medications (Xanax XR), and anti-hypertensives (Toprol XL, Verapamil XL). Because these formulations are intended to be absorbed over 2-12 hours, the pills may pass through the gastrointestinal tract before absorption is complete.

This same principle also applies to delayed-release and enteric- or film-coated pills, which are coated with a material that prevents the medication from being released until the pill moves through the stomach to the small intestine. (Sometimes the abbreviation “EC” is added to the name of a drug to indicate that it is enteric-coated.) Immediate-release dosage forms should be substituted, although they may need to be taken more often.

Now, that ALL being said...I take Aleve.  Almost daily (and multiple pills).  I didn't touch the stuff for six years, but when I started having hip problems three years ago, I gave in.  I make sure I take it with food, and I haven't (knock on wood) had any issues yet.

And now an even bigger issue (in my eyes).  Now that I have been told I have heart inflammation, my doctor has prescribed a baby aspirin.  Daily.  That one scares me more than the Aleve.  I don't know why.  So I take my baby aspirin in the morning with food.  And I make sure I don't take Aleve until later in the day after I get to work (now that I've swapped hip pain out for foot pain thanks to my heel spur).  I don't want to over-do it. 


I have never been a coffee drinker, so I will admit, this one was no big deal for me.  Or so I thought.  I have, however, in the last few years, picked up a Vitamin Water habit.  The yellow Energy Vitamin Water has a little bit of caffeine in it.  I drink it because it's yummy, not because I think I'm getting vitamins. And it isn't carbonated and has way fewer calories than soda anyway.  A bottle supposedly has about a quarter of the amount of caffeine as a cup of coffee.  Guess what, it's enough that I get headaches when I don't drink it now.  How did I get a caffeine monkey on my back?!

Anyway, according to LiveStrong, there are a few reasons not to drink caffeine: 

According to Scott J. Belsley, M.D., a board-certified surgeon and robotic surgery researcher, you should be cautious in drinking caffeine -- whether in coffee or other beverages -- following weight-loss surgeries. Caffeine is the subject of a lot of research, much of which is contradictory. Caffeine is known to increase stomach acid, causing indigestion and possibly leading to an ulcer. Even decaffeinated coffee can upset your stomach. Some studies suggests coffee increases your risk for a gastrointestinal bacterial infection called H pylori, as well as acid reflux, but the research has been inconclusive. Caffeine is a known diuretic that may slow healing. You need to control fluid intake and output after your surgery, according to the American Society for Metabolic and Bariatric Surgery, which recommends waiting a bit after surgery before adding coffee or caffeinated beverages to your diet.
Most reports I've read that say drinking coffee isn't the worst thing you could do post-surgery, say to wait at least six months to start that habit back up.


This is a biggie.  Not just from a potential ulcer standpoint.  Alcohol is a problem for those who may be switching addictions.  Before we get back to ulcers, you may want to read up on some of these articles relating to alcohol and gastric bypass:

Researchers believe gastric bypass surgery also changes how the body digests and metabolizes alcohol; some people who've had the surgery say they feel alcohol's effects much more quickly after drinking less, compared to before the procedure. The study suggests that may cause problem drinking.

The results showed peak BAC percentage of patients after drinking five ounces of red wine was significantly higher post-operation. BAC was 0.024 percent at pre-operation and 0.059 percent (p = 0.0003) at three months. Tested again at six months post-operation, the patients’ BAC was 0.088 percent (p = 0.0008) which is more than the legal driving limit of .08 percent. Additionally, it took 49 minutes for patients to reach a zero BAC prior to their operation compared with 61 minutes at three months and 88 minutes at six months post-operation.

Ok, but let's get back to those ulcers.  Here is a blurb that sums it up pretty nicely in one paragraph:

Alcohol is basically a type of sugar and it slows down a patient’s weight loss and may cause dumping syndrome. It contains lots of calories and is not nutritional. After surgery, alcohol enters the blood stream more quickly than before surgery. The intoxicating effects of alcohol occur sooner than before surgery and after smaller amounts are ingested. A patient who has had gastric bypass surgery absorbs FOUR times as much alcohol from a given drink versus before surgery. It is best to avoid drinking alcohol for at least six months after surgery, since it can be irritating to the stomach pouch and cause ulcers. You may choose to drink alcohol after the six month mark, but only do so on special, rare occasions, and NEVER drive within 24 hours of having an alcoholic beverage.

[Empahsis added.]

I realize this was a long one and I apologize for that.  I know many of us push the boundaries after gastric bypass/weight loss surgery.  Just be aware of which boundaries are less "push-able" than others.  If you have any information that you think might be helpful regarding this topic, please feel free to share in a comment below.  Thanks!



  1. You bring up some very interesting points, especially about the unfortunate tendency for patients to switch to different addictions. Following a healthy gastric bypass diet and avoiding the things on the "don't list" are very important!

  2. Damn. Double damn. Brought up interesting points and wish I'd read it a couple of years ago...for many reasons...didn't know the store brand 'tylenol' I was taking (was recommended by the pharmacist because the Vons in our area quit carrying the store brand after a recall for 18 months or so) plus I was on Prednisone for a Pituitary tumor which apparently is a known contributor to Ulcers and I was unaware of it (I haven't taken it for a couple of years now but the damage was done and had my surgery back in 2011) I also have Lupus and as such am accustomed to body pain so stomach discomfort doesn't bother me which in this case turned out to be rather dangerous because last month I was watching a movie with my husband and the next thing I knew I was in the back of an ambulance being jump started by a team of paramedics and time had passed in between with no recollection (in my underwear and embarrassed and I'm thinking...crap, how in the hell did I end up in the back of the meat wagon in my skivvies? - didn't anyone THINK to to put a bra and pants on me? holy hell! I look like a whore.) massive seizure brought on by blood loss, 5 cm ulcer that bled out...took a couple of days to stabilize me, find the bleed, etc (I was unconscious, etc) and have never smoked, drank coffee, used unprescribed drugs (thought the 'tylenol' was safe (my husband looked at the label and they clearly were marked NSAID across the label so they were NOT safe - dead giveaway right there!) and here I thought I had been avoiding them all this time! took three upper GI's to stailize the ulcer/w clips, stop bleeding, etc...nasty stuff...something definately to take seriously but I'm a healthy eater, drink tons of water (only water and tea) eat a Paleo diet, gluten/wheat free, am very careful to make sure I get full vitamins daily/w iron supplements, etc...lots of fish, etc, also passionate about rest/sleep/meditation - it's something that people who have had this procedure need to take to heart because we get rid of one set of problems and another set is just beginning and if those are ignored they can be much worse and/or life threatening. but seriously, if you end up having an emergency, here's to hoping your husband has the decency to remember your bra and pants before the effin' bus shows up.

    1. Holy have been through SO MUCH! I do wish people truly understood that this surgery isn't the magic fix. We parrot the words because our group leaders say them but we don't GET it until it's too late. That being said, I'd probably still do it again. But I am still chasing the skinny dragon, sadly. :-/ So frustrating that I know I'm being unreasonable and I can't stop myself.

  3. I would advise people to be careful when making the choice to use Aleve. I was taking only two tablets, once a week, occasionally, twice a week,but no more,for knee pain after walking. After only a few weeks I developed stomach ulcers and they were bleeding into my stomach. I had Roux-en-Y bypass surgery 17 years ago. I was in the hospital for two days, only this past week end. I was told, specifically, not to take Aleve, or Advil or any of these type of drugs on discharge. I will say, the Aleve did help me greatly, but the end results have not been pleasant.

    1. That is very, very scary. I am worried about it as well, although I take it almost daily and have been for almost three years. I also recently started taking baby aspirin for a heart issue. I don't know of any alternatives though. :-/

  4. OH boy.. I've been taking aspirin this week or so. I have an awful cold. I'm just totally miserable. I don't have any pain in my pouch though. No throwing up, no nothing. It's been almost 2 years out since I"ve had the surgery. I've taken Ibuprofen here and there as well. I don't have any signs of an ulcer?

    1. Some of us luck out and some don't. I've heard of people taking it once or twice and ending up in the ER. :-/ I've been taking Aleve almost daily for about four years and I don't have an ulcer either.

  5. I ended up with a marginal ulcer on a blood vein two months post-op, I spent a few days in the hospital when it started bleeding and I lost 2.5 liters of blood. Here it is in December, four months later, and I'm still battling the damn ulcer. I take Protonix twice a day and still have off days where I'm in pain and can't eat. They cannot figure out how I ended up with the ulcer. No caffeine, no smoking, no NSAIDs, no alcohol, and no h. pylori. My surgeon is saying he wants to wait a little longer but I'm saying let's get a revision done and over with.

    Just a heads up, you can do everything right and still have this complication.

    1. I'm so sorry to hear that!! I do agree...even if you do everything right, there are no guarantees. I hope you are healing well!! <3

  6. Are there any home remedies to ease pain of an ulcer until seeing the doctor?

    1. Angie, I don't know of any home remedies for ulcers. You should take them very seriously, though, and get to the doctor as soon as possible. Bleeding uclers are so dangerous. <3

    2. George's Aloe 1-2 ounces twice a day will coat and soothe your stomach. See your Surgeon as soon as possible also

  7. Sadly, I disobeyed the rules as well. Especially the one regarding no Advil. I over used and abused it probably after 1-2 years after having surgery. I should have known better, especially lately after taking it and getting severe pain in my pouch. I knew better, of course. And I would have the Angel on one side of my shoulder with the Devil on the other side and I don't know why I listened to the Devil more. Who knows? We all think we are invincible I guess. And we "Push the Envelope" so to speak, thinking, "Well, I was okay this time, so, I should be okay the next time." Unfortunately, I thought I would still be okay one too many times. For almost 2 weeks now I have had pain and discomfort and pulsating aches, dull and sharp, at all different times, although especially at night time. I have been awakened with pain. I have felt pain going around into my back. I had a slew of health problems prior to surgery obviously and still have my share even after surgery. However, I truly believe having gastric by-pass in October, 2011, did save my life in the long run and was the right choice for me. And as one other person commented, I would still do it again. But now I am almost certain through self diagnosis, that I have to have a Peptic Ulcer. I already had a routine appointment set up with my Gastroenterologist this coming Tuesday, but I am thinking that I should still probably go to see my Internist regardless. I also believe I should probably go back to see my Bariatric Surgeon as well for this issue. I am just so angry with myself. I had been on such a high for the past 3 years with all my success and was able to go down from 25 pills a day and 4 shots a day, to now only 7 pills a day. So, I felt really fantastic about that most of all....Not to mention that I lost 90 lbs and went down 10 sizes in clothes. Now obviously I don't know the extent of the damage yet, but, I am just wondering what I can do myself, what home remedies for relief and possible healing, (if any), can I do until I see my doctors? Also, can ulcers actually be healed completely and for good once you have them, or is this really probably just a Pipe Dream?!? I had a great-uncle once who was famous for home remedies and he was the "talk" of the family, because he had healed his ulcer(s), by eating only "Baby Food" for an entire year! However, he did not have gastric-by pass and I did not know the details/extent of his ulcer(s). How can I help myself now if at all possible? Any advice would be appreciated. And I will even take hearing the brutal facts of my actions....sadly.....I wish I could turn back time and take it all away. :(

    1. I hope that the damage isn't that great. Twice in my life, I have had pain in my pouch, which ended up just being extra acid and not actual ulcers. Please let me know how you are doing! Now when my tummy is upset, I take DGL. It is better than taking things like Prevacid. We do need acid to digest our food, unfortunately. :-/

  8. Post-RNY ulcers are no joke! I had gastric bypass in 2009. In December of 2012, after two years of horrid regular periods that led me to pop Midol Complete (Tylenol + IBUPROFEN + CAFFEINE - the last two are no-nos, obviously!) several times a day, for seven days, every single month for those two years, I started having random bouts of abdominal pain - unexplained, severe pain that nothing alleviated. On February 18th, 2013, while dealing with a bad bout of pneumonia, an ulcer I didn't know I had perforated - literally blew a hole in the small intestine that connects to the bottom of my stomach pouch. Two ERs, two ambulance rides, and six hours later, my bariatric surgeon told me about the thumbnail-sized hole she had to close up.

    Fast forward two years later: I take 40mg of Protonix (RX strength Pantoprazole) and 4g of Carafate per day. Even though I have uphill battles with my PCP and ortho I refuse NSAIDs and other stomach-irritating medications. And I have EGDs every six months. The last one, in February of this year, gave me some assurance, finally: I went from two active ulcers to just one nearly-healed one. Yay!

    Moral of the story: stress and NSAIDs can literally kill you after gastric bypass surgery. Avoid both at all costs, limit caffeine, coffee, tea, and other stomach-irritating products as much as possible. And for God's sake, don't ignore significant stomach pain like I did - a simple 20 minute EGD can find the culprit (ulcer).


    1. I'm so sorry you went through that!! Thank you for sharing your story! I'm glad you seem to be doing better.

  9. P.S. I stopped taking Aleve and aspirin after some stomach issues a couple of years ago. I was on my way to creating an ulcer. I took a round of Prilosec and am ok. I also now take DGL if my stomach is upset. I avoid tums and Prilosec type medicines if I can. We actually need acid to digest our food so we are already at a disadvantage if we have had gastric bypass. To further suppress what little acid we have causes other issues down the line.