1. Diagnosis and treatment of chronic abdominal pain 5 years after Roux-en-Y gastric bypass.
- Author
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Blom-Høgestøl IK, Stubhaug A, Kristinsson JA, and Mala T
- Subjects
- Abdominal Pain diagnosis, Abdominal Pain therapy, Chronic Pain diagnosis, Chronic Pain etiology, Chronic Pain therapy, Dumping Syndrome diagnosis, Dumping Syndrome etiology, Dumping Syndrome therapy, Female, Food Intolerance diagnosis, Food Intolerance etiology, Food Intolerance therapy, Gallstones diagnosis, Gallstones etiology, Gallstones therapy, Hernia, Abdominal diagnosis, Hernia, Abdominal etiology, Hernia, Abdominal therapy, Humans, Irritable Bowel Syndrome diagnosis, Irritable Bowel Syndrome etiology, Irritable Bowel Syndrome therapy, Male, Middle Aged, Obesity, Morbid surgery, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Pain, Postoperative therapy, Prospective Studies, Retrospective Studies, Treatment Outcome, Abdominal Pain etiology, Gastric Bypass adverse effects
- 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., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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