Recurrent ulcers after gastric surgery: endoscopic localization to the gastric mucosa

The traditional teaching has been that ulcers recurring after ulcer surgery occur at, or distal to, the anastomosis of the gastric and intestinal mucosa. These concepts predate the widespread availability of fiberoptic endoscopy. We noted that recurrent ulcers were frequently located in the gastric mucosa proximal to the gastrointestinal anastomosis. We analyzed our cases for the purpose of identifying the location of ulcers that occur after surgery for peptic ulcer disease and to investigate the possible relationship between indication for the original ulcer surgery and the presentation of the recurrent ulcer. Ulcers after peptic ulcer surgery were most frequently located in the gastric mucosa proximal to the intestinal anastomosis. The location of the recurrence was not found to be related to the original diagnosis, to the indication for the operation, or to the presentation of the recurrence. These findings may reflect either a change in the pattern of ulcer recurrence or an altered pattern of recognition related to the routine use of endoscopy.