Marginal Ulcer: Diagnosis and Treatment

  • Ye Tian
  • Ann M. RogersEmail author


Marginal ulcers, occurring on the intestinal aspect of gastrojejunal anastomoses, are seen in up to 16% of patients after gastric bypass, often within the first postoperative year. Marginal ulcers may be related to technical factors or to patient factors such as diabetes, smoking, alcohol use, and steroid or nonsteroidal anti-inflammatory drug use. Patients present with abdominal pain, nausea, vomiting, dysphagia, and hematemesis. A significant percent of patients may present with massive bleeding or perforation, despite having no prior symptoms. Endoscopy should be the first diagnostic step when it is suspected in non-emergent cases. Management is with proton pump inhibitors with or without sucralfate, removal of offending agents, and treatment of Helicobacter pylori infection if present. Surgical intervention is necessary in selected cases.


Gastric bypass Marginal ulcer Bypass complications Gastrojejunostomy Bariatric surgery 


  1. 1.
    Steinemann DC, Bueter M, Schiesser M, et al. Management of anastomotic ulcers after roux-en-Y gastric bypass: results of an international surgery. Obes Surg. 2014;24:741–6.CrossRefGoogle Scholar
  2. 2.
    Coblijn UK, Lagarde SM, de Castro SMM. Symptomatic marginal ulcer disease after roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25:805–11.CrossRefGoogle Scholar
  3. 3.
    Racu C, Mehran A. Marginal ulcers after roux-en-Y gastric bypass: pain for the patient…pain for the surgeon. Bariatric Times. 2010;7(1):23–5.Google Scholar
  4. 4.
    Nguyen NT, Hinojosa MW, Gray J, Fayad C. Reoperation for marginal ulceration. Surg Endosc. 2007;21:1919–21.CrossRefGoogle Scholar
  5. 5.
    Chaves LCL, Borges IKLC, de Souza MDG, et al. Inflammatory disorders associated with helicobacter pylori in the roux-en-Y gastric pouch. Arq Bras Cir Dig. 2016;29(Suppl 1):31–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Penn State Health Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

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