When Is Surgery Necessary for Gastric Ulcers?

Gastric ulcers are a common type of benign stomach condition. While most cases can be effectively managed with medical treatment, there are specific situations where surgical intervention becomes necessary. Below are the primary scenarios that may require surgery:

Perforation
One of the most serious complications of gastric ulcers is perforation. When an ulcer erodes through the wall of the stomach and causes a perforation, emergency surgery is typically required. This involves repairing the hole in the stomach lining. Following the procedure, patients usually continue with medical therapy to promote healing and prevent recurrence.

Major Bleeding
Severe bleeding caused by a gastric ulcer can be life-threatening. If endoscopic treatments fail to stop the bleeding, surgical options such as subtotal gastrectomy (removal of part of the stomach) may be considered. In some cases, direct surgical intervention on the affected area of the ulcer may also be performed to control hemorrhage.

Scar-Related Pyloric Obstruction
When chronic ulcers lead to scarring and narrowing of the pylorus—the opening between the stomach and the small intestine—it can result in pyloric obstruction. This condition prevents normal food passage and often requires surgical correction through a procedure like subtotal gastrectomy to restore digestive function.

Malignant Transformation
Although rare, gastric ulcers can develop into stomach cancer. When an ulcer is diagnosed as cancerous or shows signs of malignant transformation, a more extensive surgical procedure—such as a radical gastrectomy—is necessary to remove the tumor and surrounding lymph nodes to improve long-term survival.

Despite these surgical indications, it's important to note that modern medical therapies have significantly reduced the need for operations. Today, the majority of gastric ulcers are successfully treated with medications such as proton pump inhibitors, antibiotics (for H. pylori infection), and other gastroprotective agents. Surgery remains a secondary option reserved for severe or refractory cases.

If you suspect you have a gastric ulcer, it's crucial to seek professional medical advice early to avoid potential complications and ensure appropriate care.