Horror stories about surgery make nurse wary

Dear Dr. Roach: I am a 64-year-old woman who has a longstanding history of gastric ulcers verified by eight endoscopies. The most recent gastroenterologist told me that he believes they are chronic and that I should have stomach surgery to cut out the part of the stomach where the ulcer is.

I am a registered nurse who has heard horror stories concerning stomach surgery. I was thinking about having a surgical consult, but none of the surgeons I have contacted has expertise in this area. What do you think?

S.L.

Stomach ulcers once were thought to be caused by stress, but that thinking was upended when scientists in Australia discovered bacteria inside stomach ulcers and one physician inoculated himself with a bacterial culture, causing ulcers.

These were then cured with antibiotics and bismuth salts. It is now thought that most ulcers are caused by infection from these bacteria, called Helicobacter pylori (for their spiral shape and the location near the pylorus, the stomach outlet).

With eight endoscopies, you certainly should have had a biopsy to look for this infection, but it also can be diagnosed with stool or breath tests (blood tests are less precise).

Another cause of ulcers is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen.

However, my concern is that if you never had H. pylori and you don’t take regular NSAIDs, the ulcer could be caused by abnormal growth, either precancerous or cancerous.

I suspect your most recent gastroenterologist is worried about this possibility as well. Even though you may have had several biopsies, a persistent ulcer with no clear cause is highly worrisome, and surgical intervention is clearly worth considering.

To find a surgeon with expertise in your area, start by looking at the website of a teaching hospital near you, and find a surgeon with expertise in stomach cancer. I am not saying that I think you have stomach cancer, but that an expert in stomach-cancer surgery would be a good choice to provide you with a surgical opinion.

Dear Dr. Roach: I saw that the U.S. Preventive Services Task Force recommends aspirin to prevent colon cancer. Should everyone be taking an aspirin a day?

D.L.G. In September 2015, the task force issued a draft recommendation statement that adults ages 5069 should at least consider lowdose aspirin (such as an 81-milligram tablet daily or 325 mg every other day) in order to prevent both heart disease and colon cancer for those who have a 10 per cent or greater risk for heart disease (a calculator is available at cvdrisk.nhlbi.nih.gov).

The studies on aspirin for the prevention of heart disease have had conflicting results, with several new studies unable to confirm the significant benefit seen in older studies.

Also, aspirin can cause bleeding, especially of the stomach, and this bleeding can rarely be serious, even life-threatening. For these reasons, some experts have disagreed with the task force.

In fact, the draft recommendations specifically exclude people who have an increased risk of bleeding, since the risk of aspirin is too high in that group (those who have no known disease).

On the other hand, studies have been consistent that men and women who take low-dose aspirin have lower risk of developing colon cancer, which would provide an additional benefit to taking aspirin.

Since the balance of risks and benefits is so highly dependent on individual factors for heart disease, colon cancer and bleeding, only your own medical provider can work with you to make a decision about whether aspirin is right for you.