A gastrojejunal ulcer is the condition that is defined as an ulcer that recurs after gastric surgery, and is usually located at the margin where the stomach was joined to the jejunum. The jejunum extends from the duodenum to the ileum of the small intestine.

Causes of the recurrence may include: inappropriateness of the primary operation; inadequacy of the primary operation; a hypersecretory state, e.g., hypercalcemia; drugs that cause ulcers, e.g., nonsteroidal anti-inflammatory drugs (NSAID); and persistent Heliobacter (H) pylori infection.

Abdominal pain in the epigastric area commonly occurs. The pain may or may not be relieved by food or antacids, and may tend to linger and become worse.

Endoscopy is most useful in establishing the diagnosis, and is usually required to visualize ulceration at the stoma. Measurement of plasma gastrin in the fasting state is a diagnostic measure, and barium x-rays are considered to have some value.

Histamine blockers and proton pump inhibitors have been reported to promote healing. If the patient has not had a satisfactory vagotomy, a repeat vagotomy may be effective. Treatment of H. pylori is of uncertain value in anastomotic ulceration. Repeat surgery may be necessary if the ulcer does not heal.

Some studies report that 15 years after a partial gastric resection, there was an increase in the incidence of cancer in the stomach in patients who had a duodenal ulcer.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• Anemia of chronic disease due to any GI disease should be rated together with the basic disease. If the anemia is pernicious and associated with neurological manifestations. Each manifestation, e.g., neuropathy and/or other neurologic involvement, should be rated separately.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied  38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.[38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CR 4.114.  [38 CFR 4.113]

• Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach or duodenum in comparison with those at an anastomotic stoma are sufficiently recognized as to warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that the findings adequately identify the particular location.” [38 CFR 4.110]