Marginal Ulcer: Diagnosis and Treatment

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.