Abstract
Marginal ulcers are reported to occur in 1–16% of patients after a Roux-en-Y gastric bypass (RYGB). They vary in presentation, but most commonly present with upper gastrointestinal discomfort and can lead to hemorrhage, perforation, and death. Various risks factors for the occurrence of marginal ulcers have been identified and include smoking, NSAID use, H. pylori infection, and diabetes. Although there is no standardized regimen, many authors have advocated the benefits of prophylaxis with proton pump inhibitors (PPIs) after gastric bypass. Marginal ulcers are diagnosed on upper GI endoscopy and treated with therapeutic dose of PPIs and cytoprotective agents such as sucralfate. It is important to reduce the harming factors in order to promote healing. In case of refractory ulceration, revisional surgery is indicated. Presentation of an ulcer with bleeding can usually be controlled with endoscopic techniques but might warrant emergency surgery. Perforation from a marginal ulcer is managed with emergent surgery and omental patch with favorable outcomes if treated in a timely manner.
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