Refers to the occurrence of an ulcer at or near the anastomosis site after gastrojejunostomy, also known as recurrent peptic ulcer.

bubble_chart Diagnosis

Medical History Inquiry:

History of peptic ulcer with gastric resection, symptoms similar yet different from those before the peptic ulcer surgery, with abdominal pain being the most common, often paroxysmal. Night pain is significant, often radiating to other areas, with a longer stage of attack and a shorter stage of remission. Eating or antacids can temporarily relieve symptoms. Poor appetite, nausea, vomiting, and weight loss are relatively common, and some patients may develop complications such as perforation, obstruction, and bleeding.

Physical Examination Findings:

The site of abdominal tenderness often coincides with the site of abdominal pain, and there may be abdominal muscle tension at the site of pain. In long-term cases, a mass may be palpable in the abdomen.

Auxiliary Examinations:

Fecal occult blood: Can be persistently positive during ulcer activity.

Endoscopy: Common ulcers are located on the side of the anastomosis to the small intestine, mostly single ulcers, accompanied by mucosal erosion, congestion, and edema. Biopsy can exclude malignant ulcers.

Gastric acid secretion test: Shows increased BAO, with MAO significantly increased by pentagastrin or augmented histamine method. Serum gastrin levels may be elevated. X-ray barium meal examination shows anastomotic deformity, stenosis, barium retention, niche, and local tenderness in about half of the cases.

bubble_chart Treatment Measures

Initial treatment should involve internal medicine with anti-ulcer therapy, which can be extended to 3 months. If drug treatment is ineffective, surgical intervention may be considered.