nsaids.... Curious

Ok here's my question..... If you have always taken Advil or Aleve and never gotten an ulcer, why would you get one after gastric bypass?

The NP in my center told me with a VSG I have a big suture line that is volatile to ulcers. I had been prescribed Naproxen short term (like 10 days worth) for joint pain in my finger... so I didn't get a refill.

Meg

Once our staple line heals, it's stronger than it was before. There is no reason we can't take NSAIDs once the initial healing period is over.

Two issues as I see it.  One is that now you have seams where you didn't before.  The other is that you can get an ulcer in your remant stomach and there is no way for them to find it except for surgery.  It can't be seen by scope.  That is why sleevers can still take NSAIDs and we can't.

I decided to do some research because I just took everyone's word that I shouldn't take this, but with your questions I wondered why.  I know that it is known to cause ulcers.

Here is the information I got from: http://www.obesityhelp.com/forums/amos/MEDICATIONS-After-Bar iatric-Surgery-wls.html

 

Medications and Marginal Ulcers

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.

The same risk extends to the salicylates (i.e., aspirin), but the risks and benefits of daily aspirin therapy should be considered on an individual basis. Safer options for oral pain medications include acetaminophen and opioids (Percocet, Vicodin, Tylenol #3 and Tramadol).

Oral biphosphonates are another type of medication that may produce marginal ulcers in gastric bypass patients. These drugs inhibit the loss of bone mass associated with bone diseases like osteoporosis and Paget’s disease; commonly used biphosphonates include Actonel, Aredia, Boniva, Didronel, Fosamax, Reclast, Skelid and Zometa. However, there are alternative treatment options available, such as calcitonin salmon nasal spray, synthetic parathyroid hormone and Raloxifene.

Anti-acid medications (Nexium, Protonix or Prevacid) are prescribed to prevent ulcers in the gastric pouch. We recommend taking one of these for at least six months following any type of bariatric surgery.

I hope this post where you can read it.  I'm having a hard time getting it on the page.

Linda

My understanding is that NSAIDs thin the walls of the stomach. It's not as big a deal with a full-sized stomach and with a stomach with a pylorus valve for it's connection. But RnY has a stoma and the rouex limb attached to it and that is suspectable to ulcers even without taking NSAIDs. So taking NSAIDs increases the risk even more.

Also, the blind stomach can't be easily scoped as was mentioned elsewhere. But if there was no increased risk, that might  not be a big consideration.

I was advised that even with the sleeve, ongoing use with NSAID's, might require the use of an acid reducer. Just like someone with a normal stomach.

What I've seen is that lots of doctors hate NSAIDs and use our sleeves as an excuse to tell us not to take them. But when you do a search of the scientific literature, there is no evidence that people with sleeves in particular and partial gastrectomies in general are more suseptible to ulcers from taking NSAIDs. However, NSAID use in general increases the risk of ulcers in the unaltered population.

So basically, from what I've read, our risk is the same as it was pre-op. If NSAIDs bothered you pre-op, they will probably bother you post-op. Also, there are lots of other good reasons not to take them. It's just the having a sleeve isn't one of them.

With the bypass, it's not the fact that they have a pouch (which is a form of partial gastrectomy) which is the issue... it's the new connections which are not an issue with partial gastrectomies done to treat uclers and cancer.

Also, there are studies showing that taking a PPI with a NSAID doesn't help prevent ulcers. Here is one such study:

http://www.springerlink.com/content/h471132581r33815/

(Achlorhydria means 'lack of stomach acid')

 "our risk is the same as it was pre-op. If NSAIDs bothered you pre-op, they will probably bother you post-op."


That is what I was told pre-op, when I had my pre-op appointment with the surgeon.

I have to take 2 baby ASAs/day due to A-Fib, so chances are, I'll have to be on a PPI long term. I have tried going off of protonix, but haven't had any luck. I don't think the difficulty is related to the baby ASA, but with the sleeve issue.

Thanks for the article. I'll read the study, when I have more time. Ulcers develop, regardless, if people are taking an acid reducer or PPI. Some people are just more susceptible.

Gail