Ulcers and Strictures After Bariatric Surgery

Ulcers and Strictures After Bariatric Surgery


Ulcers and strictures may occur after weight loss surgery. 

  • An ulcer may occur at any time after a gastric bypass. It is the breakdown in the lining of the digestive tract often at the connection between the pouch and small bowel. This can cause pain, especially with eating. 
  • A stricture happens after gastric bypass when part of your digestive tract narrows, often at the connection between the pouch and small bowel. This makes it hard for food to pass. This can cause a feeling of food or pills being “stuck,” nausea, vomiting, and/or feeling full longer.
     

Causes of ulcers

The following things can make you at higher risk for getting ulcers after weight loss surgery:

  • Nicotine use or exposure to tobacco smoke*
  • Nonsteroidal antiinflammatory drug (NSAID) use, including aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and Excedrin*
  • Making a lot of stomach acid
  • Reduced blood flow to the stomach
  • Frequent dehydration, where you lose more water than you take in
  • Drinking a lot of alcohol
  • Stress
  • Steroid use, including Prednisone

*Nicotine and NSAIDs are responsible for about 80% of ulcers forming.
 

Causes of strictures

People who have had weight loss surgery are at highest risk of getting strictures 3 to 8 weeks after surgery, but some patients may get them later. 

Strictures can be caused by:

  • Buildup of scar tissue during healing
  • Lack of blood flow to the area
  • Ulcers
  • Smoking
  • Frequent dehydration
     

Diagnosis and treatment 

Ulcers and strictures are most often diagnosed with an endoscopy, a procedure that looks inside the body to see changes to the lining of the pouch and small bowel. They may also be diagnosed with X-rays and CT scans. 

Ulcers are most often treated with medicines, such as:

  • Omeprazole (Prilosec) – This medicine comes as a capsule. To take the medicine, open the capsule, put the medicine into unsweetened applesauce, and then take it by mouth. 
  • Sucralfate (Carafate) – This medicine comes as either a liquid suspension or a tablet. To take the tablet, put it into a teaspoon of water to make a slurry, and then take it by mouth.

Strictures are most often dilated or stretched with a balloon during an endoscopy. Multiple dilations may be needed. 

Severe ulcer disease and strictures that do not respond to treatment may need surgery to correct.
 

Diet for bariatric surgery patients with an ulcer or stricture

If you have signs of an ulcer or stricture, the foods listed below may be easier for you to eat. Each person tolerates foods differently, so try foods cautiously. Foods high in fat, fiber, or acid (like citrus fruits and tomatoes) tend to cause pain.

General Guidelines

  • Every meal/snack should contain a protein source. This can be from the milk or meat group. Vegetarian options can be found in the meat group as well. Your goal is to get 60 to 80 grams of protein per day. Sometimes it is easier to get protein from shakes when you have an ulcer or stricture.
  • Sip at least 64 ounces of sugar free, caffeine free liquids each day. Drink about 1 ounce every 3 to 5 minutes (or 6 ounces every 20 to 30 minutes). Sugar free liquids include Crystal Light, V8 Diet Splash, tomato juice, V8 low sodium vegetable juice, sugar free Kool-Aid, sugar free decaf iced, flavored waters, sugar free popsicles, sugar free gelatin, and broth. Avoid drinks with alcohol, caffeine, and carbonation.
  • Solid foods should be soft. Avoid all raw fruits and vegetables, nuts, seeds, popcorn, and pickles until the bariatric surgery care team tells you to add them back into your diet.
  • Stop taking calcium supplements until your provider tells you to resume taking them. It is okay to take your daily multivitamin with calcium, but any extra calcium should be stopped to avoid it causing stomach upset.
     

Planning Meals

Use foods from these groups to plan your meals.

Milk Group

Choose up to 4 servings from this food group each day. Check sugar content. These foods are good sources of protein and calcium:

  • ½ cup fat free skim or 1% low fat milk
  • ½ cup Lactaid milk or other unsweetened soy milk
  • ¼ cup light yogurt (remove any pieces of fruit in yogurt)
  • ¼ cup cottage cheese
  • ½ bottle (6 to 8 fluid ounces) of protein shake or protein water 
  • ¼ cup sugar free pudding (boxed) made with fat free skim milk
  • ¼ cup strained cream soup made with fat free skim milk

Meat Group

Choose up to 4 servings from this food group each day. These foods are good sources of protein, energy, B vitamins, and iron:

  • ½ small jar strained baby food meat (plain)
  • 1 tablespoon creamy peanut butter. Caution: People with ulcers should avoid nut butters due to their high fat content, which can make an ulcer worse. People with strictures may slowly take very small licks of nut butter straight from a spoon. 
  • 1 egg (soft scrambled) or egg salad (smashed/blended)
  • ¼ cup (1 ounce) soft tofu

Vegetable Group

Choose up to 1 or 2 servings from this food group each day. These foods are good sources of vitamins, minerals, and fiber and are low in calories:

  • ½ small jar of strained baby food
  • ¼ cup cooked (soft) vegetables, such as beets, cabbage, carrots, green beans, greens, spinach and zucchini. Avoid all raw vegetables.

Fruit Group

Choose up to 1 or 2 servings from this food group each day. Avoid strained fruit desserts and junior or toddler foods. These foods are good sources of vitamins, minerals, and fiber.

  • ¼ to ½ raw banana. Avoid all other raw fruits.
  • ½ cup diet juice with 5 calories or less per serving
  • ½ cup homemade smoothie
  • ¼ cup unsweetened applesauce
  • ½ small jar strained baby food

Starch Group

Choose up to 1 or 2 servings from this food group each day. These foods are good sources of energy, B vitamins, and iron (if fortified):

  • ½ cup soup. Avoid soups with pasta or rice.
  • ¼ cup cooked cereal, such as Cream of Wheat, oatmeal, and grits
  • ¼ cup cooked (soft), starchy vegetable, such as mashed winter squash, mashed potatoes, and mashed sweet potatoes
  • ¼ cup canned fat free or vegetarian refried beans
  • ¼ cup pureed peas or lentils

Note: Avoid bread, rice, pasta, and similar grains.

Fats

Choose up to 2 servings from this food group each day. Sometimes fats are poorly tolerated in patients with ulcers, so try cautiously. These foods are low in vitamins and high in calories:

  • 1 teaspoon butter or oil
  • 2 teaspoons diet margarine
  • 1 tablespoon low fat mayonnaise, Miracle Whip, or salad dressing
  • 1 tablespoon avocado, blended
  • 1 tablespoon low fat or fat free gravy


© 2017 – May 8, 2023, The Ohio State University Wexner Medical Center

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care. For more health information, call the Library for Health Information at 614-293-3707 or email: health-info@osu.edu.