An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass

Pernar, Luise I.M.; Lockridge, Ryan; McCormack, Colleen; Chen, Judy; Shikora, Scott A.; Spector, David L.; Tavakkoli, Ali; Vernon, Ashley H.; Robinson, Malcolm K.

doi:10.1007/s11695-016-2324-8

Cited by 7 publications

(10 citation statements)

References 10 publications

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“…The risk was higher among women, young subjects, smokers, unemployed subjects, and subjects with symptoms from previous surgeries [23]. In several studies abdominal pain has been identified as the most common symptom, causing additional health care contacts and hospital readmissions with a prevalence up to 61.4% (Table 1) [8,[22][23][24][25][26][27][28][29][30][31]. Chronic abdominal pain was found to be associated with reduced health related quality of life [22].…”

Section: Prevalencementioning

confidence: 99%

Chronic abdominal pain and persistent opioid use after bariatric surgery

Simoni

Ladebo

Christrup

et al. 2019

Scandinavian Journal of Pain

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Background and aimsBariatric surgery remains a mainstay for treatment of morbid obesity. However, long-term adverse outcomes include chronic abdominal pain and persistent opioid use. The aim of this review was to assess the existing data on prevalence, possible mechanisms, risk factors, and outcomes regarding chronic abdominal pain and persistent opioid use after bariatric surgery.MethodsPubMed was screened for relevant literature focusing on chronic abdominal pain, persistent opioid use and pharmacokinetic alterations of opioids after bariatric surgery. Relevant papers were cross-referenced to identify publications possibly not located during the ordinary screening.ResultsEvidence regarding general chronic pain status after bariatric surgery is sparse. However, our literature review revealed that abdominal pain was the most prevalent complication to bariatric surgery, presented in 3–61% of subjects with health care contacts or readmissions 1–5 years after surgery. This could be explained by behavioral, anatomical, and/or functional disorders. Persistent opioid use and doses increased after bariatric surgery, and 4–14% initiated a persistent opioid use 1–7 years after the surgery. Persistent opioid use was associated with severe pain symptoms and was most prevalent among subjects with a lower socioeconomic status. Alteration of absorption and distribution after bariatric surgery may impact opioid effects and increase the risk of adverse events and development of addiction. Changes in absorption have been briefly investigated, but the identified alterations could not be separated from alterations caused solely by excessive weight loss, and medication formulation could influence the findings. Subjects with persistent opioid use after bariatric surgery achieved lower weight loss and less metabolic benefits from the surgery. Thus, remission from comorbidities and cost effectiveness following bariatric surgery may be limited in these subjects.ConclusionsPain, especially chronic abdominal, and persistent opioid use were found to be prevalent after bariatric surgery. Physiological, anatomical, and pharmacokinetic changes are likely to play a role. However, the risk factors for occurrence of chronic abdominal pain and persistent opioid use have only been scarcely examined as have the possible impact of pain and persistent opioid use on clinical outcomes, and health-care costs. This makes it difficult to design targeted preventive interventions, which can identify subjects at risk and prevent persistent opioid use after bariatric surgery. Future studies could imply pharmacokinetic-, pharmacodynamics-, and physiological-based modelling of pain treatment. More attention to social, physiologic, and psychological factors may be warranted in order to identify specific risk profiles of subjects considered for bariatric surgery in order to tailor and optimize current treatment recommendations for this population.

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Section: Prevalencementioning

confidence: 99%

Chronic abdominal pain and persistent opioid use after bariatric surgery

Simoni

Ladebo

Christrup

et al. 2019

Scandinavian Journal of Pain

View full text Add to dashboard Cite

show abstract

“…Similarly, in a national Danish cohort, at least 15% was acutely admitted to hospital for abdominal pain (12). In an American series, 22% of the patients met at the emergency department with abdominal complaints that typically led to abdominal computer tomography (CT) scans (13). In a Dutch study (mostly RYGB), abdominal pain was described in medical files of 21.6% of the patients (14).…”

Section: Prevalencementioning

confidence: 99%

“…The order of the investigations depends on symptoms and suspected cause. Increased exposure to radiation post RYGB is a concern due to increased use of abdominal imaging, often without relevant findings (13, 15, 16). A comprehensive exploration of symptoms can guide initial radiologic assessment.…”

Section: General Diagnostic Considerationsmentioning

confidence: 99%

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity

Mala

Høgestøl

2018

Scand J Surg

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“…However, recent reports indicate that abdominal pain is common 2–5 years after RYGB [10–12]. Internal herniation and gallstone related disease are common causes of acute pain, whereas the etiology of chronic abdominal pain after RYGB is less well understood [13–15].…”

Section: Introductionmentioning

confidence: 99%

Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

et al. 2019

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BackgroundIrritable bowel syndrome (IBS) is prevalent in patients with morbid obesity. After Roux-en-Y gastric bypass (RYGB) chronic abdominal pain is common, however the etiology is largely unknown. We aimed to study the change in the prevalence of IBS-like symptoms 2 years after RYGB and possible preoperative predictors of such symptoms. Secondly, to evaluate changes in symptoms of constipation and diarrhea, and Health related quality of life (HRQoL).MethodsPatients with morbid obesity were included at two obesity centers in South-Eastern Norway. IBS was diagnosed according to the Rome III criteria. Predictors were evaluated in a multivariable logistic regression analysis.ResultsOf 307 participants operated with RYGB, 233 (76%) completed the study questionnaires. Preoperatively 27/233 participants (12%) had IBS, 2 years after RYGB 61/233 (26%) had IBS-like symptoms (p < 0.001). Eleven participants with IBS preoperatively (41%) did not report such symptoms after RYGB. New onset IBS-like symptoms was identified in 45/206 (22%) after RYGB. Fibromyalgia, low LDL levels, high vitamin B1 levels and IBS before RYGB were independent preoperative predictors of IBS-like symptoms at the follow-up visit. Symptom scores for constipation preoperatively and 2 year after RYGB were 1.5 (0.9) and 1.8 (1.2), and for diarrhea 1.4 (0.9) and 1.8 (1.1), respectively (p < 0.001). We observed a significant improvement in the physical component score for all participants. However, participants with new onset IBS-like symptoms had a significant worsening of the mental component score.ConclusionsThe prevalence of IBS-like symptoms doubled 2 years after RYGB, and these symptoms were associated with reduced HRQoL. Preoperative IBS and fibromyalgia were strong predictors of postoperative IBS-like symptoms.

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An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass

Cited by 7 publications

References 10 publications

Chronic abdominal pain and persistent opioid use after bariatric surgery

Chronic abdominal pain and persistent opioid use after bariatric surgery

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity

Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

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