The presence of gastritis does not automatically prevent a patient from receiving Gastric Sleeve Surgery, but it requires a necessary period of medical management and delay. Gastric Sleeve Surgery, or vertical sleeve gastrectomy (VSG), removes approximately 80% of the stomach, creating a small pouch to restrict food intake and reduce hunger hormones. Gastritis is an inflammation or irritation of the stomach lining, which can be acute or chronic, often presenting with symptoms like upper abdominal pain, nausea, or a feeling of fullness. The co-existence of these conditions requires careful attention to reduce surgical risk and ensure optimal post-operative health.
Understanding Gastritis and the Gastric Sleeve
Gastritis can be caused by factors including infection with the Helicobacter pylori (H. pylori) bacteria, regular use of non-steroidal anti-inflammatory drugs (NSAIDs), or excessive alcohol consumption. This inflammation compromises the stomach’s protective mucosal layer, making it vulnerable to digestive acids. An inflamed stomach lining poses a direct risk during a sleeve gastrectomy because the procedure involves cutting and stapling the stomach tissue to create the new sleeve.
Stapling an actively inflamed or thickened stomach wall increases the risk of complications, such as staple line bleeding, impaired healing, and the potential for a gastric leak. A gastric leak is a severe complication where stomach contents leak into the abdominal cavity. Uncontrolled gastritis, particularly that caused by H. pylori, raises the likelihood of developing a post-operative ulcer. For these reasons, the inflammation must be addressed before the surgical procedure can be safely performed.
Mandatory Pre-Operative Assessment
The first step in managing gastritis before bariatric surgery is a mandatory diagnostic evaluation, typically performed through an upper endoscopy, known as Esophagogastroduodenoscopy (EGD). An EGD allows the surgeon to visually inspect the lining of the esophagus, stomach, and the first part of the small intestine. This procedure assesses the severity of the gastritis, identifies erosions or ulcers, and rules out other conditions.
During the endoscopy, tissue samples (biopsies) are taken from different areas of the stomach for lab analysis. These biopsies check for the presence of the H. pylori bacterium and evaluate the degree of inflammation. The stomach is deemed stable for surgery when inflammation is minimal and any identified H. pylori infection has been successfully eradicated. Pre-operative EGD findings often lead to a delay in surgery, ensuring the underlying condition is resolved first.
Treatment Protocols for Active Gastritis
If active gastritis or an H. pylori infection is found, surgery is postponed until the inflammation is resolved or controlled. Treatment for non-H. pylori related gastritis focuses on eliminating the source of irritation. This includes a strict mandate to stop using NSAIDs, such as ibuprofen and naproxen, and to cease tobacco and excessive alcohol consumption, as these substances damage the stomach lining.
For cases involving an H. pylori infection, a specific course of combination therapy is prescribed, lasting between 10 and 14 days. This regimen involves a proton pump inhibitor (PPI) medication, which reduces stomach acid production, combined with two different antibiotics to eradicate the bacteria. Following therapy, a follow-up test, such as a urea breath test, is required to confirm successful eradication. The surgical team will not proceed until the stomach lining has healed and the infection is confirmed to be gone, a process that can take several weeks to months.
Long-Term Management Following Surgery
The completion of pre-operative treatment does not eliminate the need for vigilance against future gastritis or ulcers after the gastric sleeve. The smaller stomach sleeve is a high-pressure system, which increases the risk of acid reflux and subsequent irritation of the stomach lining. Post-operative protocols include the use of a PPI medication for a period, typically ranging from one to three months, to protect the newly formed staple line and promote healing.
Lifelong adherence to specific lifestyle and medication rules is necessary to prevent the recurrence of gastritis and the development of post-operative ulcers. Patients must permanently avoid all NSAIDs, as these medications are highly irritating to the reduced stomach. Maintaining the post-bariatric diet is paramount for the long-term health of the gastric sleeve. This diet emphasizes small, frequent meals and the avoidance of irritants like excessive caffeine, spicy foods, and alcohol.