Barbara Bush Recovers From 'Serious' Ulcer
Former First Lady 'Resting Comfortably' After Surgery to Fix Rare Condition
By DAN CHILDS
ABC News Medical Unit
Nov. 26, 2008
Barbara Bush's surgeon said she told him her recent bout with a perforated ulcer was "the worst pain she had ever felt" at a Wednesday press conference on the 83-year-old former first lady's condition.
Bush, who was admitted to the Methodist Hospital in Houston Tuesday with abdominal pains, was suffering from a perforated ulcer, the hospital confirmed in a statement.
Dr. Pat Reardon, director of the Methodist Hospital Advanced Minimally Invasive Surgery program and the surgeon who performed the procedure, told ABC News that former President George Bush took his wife straight to the emergency room, where doctors determined that she would need surgery for her ulcer immediately.
Reardon said the surgery lasted several hours and ended at 2 a.m. ET on Wednesday. In the course of the procedure, surgeons cleansed the former first lady's abdominal area, after which they patched and closed a one-centimeter hole in her stomach that was caused by the ulcer, the hospital statement said. Bush will likely remain hospitalized until next week.
On Wednesday afternoon, Reardon said Bush was doing very well, and her vital signs were stable. In accordance with the protocol for this type of surgery, Bush will remain in intensive care for at least another 24 hours. The inflammation from the surgery will make eating impossible for her for about a week, so she will stay in the hospital for at least that long, receiving intravenous antibiotics.
On Wednesday, first lady Laura Bush told ABC "Good Morning America's" Robin Roberts that her mother-in-law is "doing great."
"The White House doctor did talk to Barbara Bush's doctor, and she's doing very well, and we're really, really thankful," Laura Bush said.
But Bush likely dodged a bullet. Calling her perforated ulcer "rare but serious," gastroenterologists said the former first lady's prognosis would have been far worse had she not sought immediate treatment.
Dr. Roshini Rajapaksa, a gastroenterologist at NYU Medical Center and assistant professor at the NYU School of Medicine, said it was fortunate that Barbara Bush's operation took place when it did, as perforations require immediate medical attention.
"The most serious complication of an ulcer is a perforation, which is literally a hole in the stomach," Rajapaksa said.
Untreated, these holes can cause acid and other stomach contents to pour into the abdominal cavity. This, in turn, can lead to inflammation, infection and other problems.
"The vast majority of people with ulcers do not need surgery, so certainly this is one of the rare but serious considerations of ulcers," Rajapaksa said.
Dr. Jeffrey Peters, chief of surgery at the University of Rochester Medical Center, agreed. "It is quite serious and most often requires emergency surgery," he said. "In someone her age, it is definitely a life-threatening issue."
Underlying Cause Still a Mystery
According to statistics from the National Institute of Diabetes and Digestive and Kidney Diseases, one in 10 Americans develops an ulcer at some time in his or her life. Moreover, about 6,000 Americans die of stomach ulcer-related complications every year.
Rajapaksa said the most common cause of ulcers is infection with a common bacterium known as H. pylori. But she added that the long-term use of aspirin, ibuprofen and other NSAID, or non-steroidal anti-inflammatory drugs, can also lead to an ulcer.
"These medicines can damage the lining of the stomach," she said.
A vast number of people use over-the-counter NSAIDs on a regular basis, and patients recovering from certain procedures may take these drugs in larger doses. In 1999, Barbara Bush underwent elective back surgery; however, at the time her family did not clarify the exact nature of her surgery.
Still, Peters said it was likely that the painkillers she received while recovering from this surgery, as well as any other similar drugs that she has taken since, contributed to her ulcer.
"There is a high proportion of the population in her age group that is on NSAIDs," he said. "Probably this is the most likely underlying cause ... Eighty percent of ulcers are caused either from chemical irritation or H. pylori."
Rajapaksa said that cancer is also a common concern among doctors when dealing with a perforated ulcer. But she added that in Barbara Bush's case, it is unlikely that cancer was the underlying cause of her condition.
"Certainly there is always the possibility of cancer," Rajapaksa said. "However, in this case it probably wouldn't have been repaired in this way, endoscopically, if it had been cancer."
Thus far, Barbara Bush's only documented brush with cancer was the removal of a small cancerous growth from her upper lip in February of 1990.
Other Health Issues
Barbara Bush has sought medical attention in the past for a number of other issues as well. In 1989, a thyroid condition known as Graves disease reportedly caused her to lose 18 pounds in three months. She later began taking medication and in 1990 received radiation therapy for her eyes as part of her treatment for this condition.
Earlier, she had received steroids to treat the condition, though her doctor later pulled her off the medication. Long-term use of steroids, too, has been linked to the development of stomach ulcers.
Fortunately, Peters says that now that her perforation has been repaired, it is unlikely that it will recur in that particular spot. And he says that the news that she is resting comfortably is a good omen.
"If 12 to 24 hours out the patient is doing well, the chances are he or she will recuperate just fine."
UPDATE (Thursday 1:37p.m.ET): Mrs. Bush was just moved out of intensive care and into a regular private room. Gina Sunseri and Radha Chitale contributed to this report.