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Surg Obes Relat Dis. 2018 Oct;14(10):1544-1551. doi: 10.1016/j.soard.2018.06.004. Epub 2018 Jun 14.

Diagnosis and treatment of chronic abdominal pain 5 years after Roux-en-Y gastric bypass.

Author information

1
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: i.k.hogestol@medisin.uio.no.
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastrointestinal Surgery and Paediatric Surgery, Oslo University Hospital, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
3
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
4
Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

Knowledge of optimal diagnostic workup, etiology, and response to treatment of chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) is limited.

OBJECTIVE:

To define the etiology of chronic abdominal pain presenting at the 5-year follow-up after RYGB and to evaluate response to treatment.

SETTING:

Oslo University Hospital (tertiary referral center for obesity surgery).

METHODS:

Of 234 patients operated during a randomly selected 12-month period, 165 (71%) returned for 5-year follow-up, and 160 responded to study questionnaires. Of these, 54 (34%) reported chronic abdominal pain and were invited to participate in a structured diagnostic and treatment algorithm. These patients were contacted for the evaluation of their response to treatment.

RESULTS:

Fifty-one of 54 patients (94%) reporting chronic abdominal pain at the 5-year follow-up were included in the study. Of the 45 patients with onset of symptoms post-RYGB, 28 (62%) underwent one or more radiologic evaluations, 10 (22%) underwent endoscopy, and 13 (29%) underwent laparoscopy. Diagnosis and treatment were established for 34 patients (76%), whereas 11 (24%) had abdominal pain of unknown cause. The most common etiology was internal herniation (n = 6), dumping (n = 6), food intolerance (n = 6), gallstones (n = 5), and irritable bowel syndrome (n = 4). After a median follow-up of 13.0 months (standard deviation, 11.5), 37 (82%) patients reported remission or improvement of symptoms, 6 had unchanged symptoms, and 2 patients were lost to follow-up.

CONCLUSIONS:

The etiology of long-term chronic abdominal pain post-RYGB is diverse. A multidisciplinary team can help most patients with dedicated follow-up, but a subset of patients has symptoms of unknown etiology.

KEYWORDS:

Abdominal pain; Abdominal wall nerve entrapment; Bariatric surgery; Chronic abdominal pain; Complex abdominal pain syndrome; Crohn's disease; Diagnosis; Diagnostic workup; Dumping; Etiology; Follow-up; Food intolerance; Gallbladder stones; Gastric pouch ulceration; Internal herniation; Irritable bowel syndrome; Obesity; Overeating; Roux-en-Y gastric bypass; Undefined abdominal pain; Visceral neuropathic pain

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