Gastric Bypass: Marginal Ulceration

Since its introduction, the ulcerogenic potential of the Roux-en-Y gastric bypass has been brought into question. Despite concerns stemming from the high incidence of stomal ulceration in previous gastric exclusion operations, this has not been found to be the case with Roux-en-Y gastric bypass, which excludes much of the acid-secreting mucosa, as well as the antrum. Mason et al. postulated that gastric acid secretion is under antral control in most people; therefore, gastric bypass operations decrease acid production. This was further demonstrated by Smith et al., who documented significantly decreased basal and pentagastrin-stimulated acid production in the gastric pouch.

Despite the predicted reduction in acid secretion, marginal ulceration can be a relatively troublesome complication of Roux-en-Y gastric bypass, with a historical incidence reported to be between 3% and 20%, and more recent literature reporting an incidence between 2% and 4%.