My mother was on a high dose of steroids, and this caused a large ulcer. She had to have half of her stomach removed. Ever since then, she has these terrible hurting spells with her stomach. She said it feels like the worst case of heartburn she's ever had. What could be the cause? This does not always happen after she eats. She also has a lot of gas.

Regina

When surgery to remove a part of the stomach (gastrectomy) is done, there can be several postoperative side effects. One common side effect, called gastroparesis, involves the loss of the stomach's normal contractile function. This occurs because during gastrectomy, doctors cut the vagus nerve -- the nerve responsible for the stomach muscle contractions that help to mix food after meals. When gastroparesis occurs, the stomach tends to empty more slowly and patients often report acid reflux, bloating and feeling full after eating only a small amount of food.

One way of preventing or lessening the possibility of gastroparesis is for the surgeon, at the time of the stomach surgery, to perform a procedure that enhances the emptying of the stomach. This may involve an enlargement of the normal sphincter that leads out of the stomach (pyloroplasty), or creating a connection between the remaining stomach and the small intestine (gastrojejunostomy). Although these methods of improving stomach emptying are very effective, many patients still experience fullness, bloating and acid reflux. In addition, both pyloroplasty and gastrojejunostomy increase the likelihood of bile entering the stomach from the upper intestine, leading to inflammation of the stomach lining (gastritis).

Therapy for gastroparesis includes dietary modification, with patients being advised to eat frequent, small meals rather than large meals. Most patients also require medications, such as drugs that bind bile acids to prevent injury to the stomach. In rare cases, further surgery may be needed to improve symptoms.

Patients with abdominal pain and heartburn after an operation for an ulcer may also be suffering from recurrent ulcers. Thus, your mother should be seen by her doctor for these complaints, and an endoscopy may be necessary to fully evaluate the remaining portion of her stomach.