A vagotomy is a resection of the vagus nerve to eliminate nerve stimulation and reduce acid secretion. A pyloroplasty is a surgical procedure performed at the pylorus where it opens into the duodenum to increase or assist gastric emptying. Gastroenterostomy occurs when an additional opening from the stomach to the small intestine is made to bypass the pylorus.

Etiologic factors basic to the surgical procedures are chronic gastric ulcers that are perforated, bleeding, or obstructed.

A sharp, burning pain in the epigastrium occurring approximately 90 minutes to 3 hours after eating is indicative of an ulcer. Pain that is accompanied with vomiting relates to a gastric outlet obstruction. Pain that is constant, unrelieved by food or antacids, and radiates to the back may signal penetration to the pancreas. Abrupt pain over the entire abdomen may be associated with perforation, and vomiting blood or "coffee ground" material and passing black, tarry stools is related to bleeding. On physical examination, there is epigastrium tenderness, and the abdomen is rigid and hard if it is perforated.

A barium x-ray examination of the upper gastrointestinal (GI) tract is the most commonly used method in detecting ulcers or obstruction. Endoscopic examination is useful in the diagnosis of ulcers not seen on x-ray or for identifying a source of bleeding.

The number of patients requiring surgery for obstruction, hemorrhage or perforation has significantly declined because of new, available medical therapies (see Diagnostic Code: 7304 Ulcer, gastric).

Possible complications from gastric surgery are: recurrent ulceration; bile reflux; dumping syndrome (see Diagnostic Code: 7308 Postgastrectomy syndromes); postvagotomy diarrhea; Vitamin B12 deficiency; anemia; osteomalacia and osteoporosis; and general malabsorbtion syndrome.

• None.

• Rate recurrent ulcer following complete vagotomy under diagnostic code 7305, minimum rating 20 percent; and rate dumping syndrome under diagnostic code 7308.

• 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 4.14.  [38 CFR 4.113]