Dr. Keith Roach: Surgical consult reasonable for longstanding gastric ulcers
Dear Dr. Roach: I’m a 64-year-old female who has a longstanding history of gastric ulcers verified by eight endoscopies. The most recent gastroenterologist told me he believes they are chronic and I should have stomach surgery to cut out the part of the stomach where the ulcer is. I’m an R.N. who has heard horror stories about stomach surgery. I was thinking about having a surgical consult, but none of the surgeons I’ve contacted has expertise in this area. What do you think?
Dear S.L.: Stomach ulcers once were thought to be caused by stress, but that thinking was upended when scientists in Australia discovered bacteria inside stomach ulcers and one physician inoculated himself with a bacterial culture, causing ulcers. These were then cured with antibiotics and bismuth salts. It is now thought that most ulcers are caused by infection from these bacteria, called Helicobacter pylori (for their spiral shape and the location near the pylorus, the stomach outlet). With eight endoscopies, you certainly should have had a biopsy to look for this infection, but it also can be diagnosed with stool or breath tests (blood tests are less precise).
Another cause of ulcers is the use of nonsteroidal anti-inflammatory drugs, such as naproxen or ibuprofen. However, my concern is that if you never had H. pylori and you don’t take regular NSAIDs, the ulcer could be caused by abnormal growth, either precancerous or cancerous. I suspect your most recent gastroenterologist is worried about this possibility, as well. Even though you may have had several biopsies, a persistent ulcer with no clear cause is highly worrisome, and surgical intervention is clearly worth considering.
To find a surgeon with expertise in your area, I would start by looking at the website of a teaching hospital near you, and find a surgeon with expertise in stomach cancer. I am not saying that I think you have stomach cancer, but that an expert in stomach cancer surgery would be a good choice to provide you with a surgical opinion.
Dear Dr. Roach: I recently was diagnosed with transient global amnesia. I had never heard of this. My primary care doctor sent me for further testing, which included an MRI and MRA with contrast, and a CT scan. All were normal. Can you elaborate further?
Dear M.T.M.: Transient global amnesia is a cause of retrograde amnesia (“retrograde” meaning you don’t remember things from the past, usually the past day to a month, but sometimes longer; “anterograde” means memory loss forward from the time of the event). Its cause is unknown, but it occurs more frequently in men and women over 50. Your doctor ordered the appropriate tests to make sure it wasn’t a TIA or stroke. Epilepsy sometimes can look similar to TGA, so sometimes an EEG is obtained.
As scary as it sounds, TGA usually doesn’t happen again and doesn’t predict a higher risk of developing memory troubles, stroke or epilepsy in the future.
Email questions to ToYourGoodHealth@med.cornell.edu.