Postbariatric Surgery Neuropathic Pain (PBSNP): Case Report, Literature Review, and Treatment Options

Kailasam, Vasanth Kattalai; Decastro, Claricio; Macaluso, Claude; Kleiman, Anne

doi:10.1111/pme.12590

Cited by 10 publications

(7 citation statements)

References 39 publications

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“…With regard to nephropathy, urinary albumin/creatinine ratio (uACR) was reduced, and both glomerular hypo-and hyperfiltration improved after bariatric surgery [6,7]. Data relating to diabetic neuropathy are contradictory, as there are reports of worsening symptomatic neuropathy, attributed to nutritional deficiencies [8] and a 33% incidence of neuropathic pain following bariatric surgery [9]. In a prospective cohort study of 20 participants undergoing bariatric surgery, there were significant improvements in the neuropathy symptom and disability scores after 6 months [10].…”

Section: Introductionmentioning

confidence: 99%

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Adam

Azmi

et al. 2020

OBES SURG

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Purpose There are limited data on the impact of bariatric surgery on microvascular complications of type 2 diabetes (T2D), particularly diabetic neuropathy. We assessed microvascular complications (especially neuropathy) in obese patients with T2D before and 12 months after bariatric surgery. Materials and Methods This was a prospective observational cohort study. Measurements of neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration (VPT), cold (CPT) and warm (WPT) perception thresholds, nerve conduction studies (NCS) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL); urinary albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFRcyst-creat) and retinal grading were taken. Results Twenty-six (62% female; median age 52 years) obese patients with T2D were recruited. Body mass index (BMI) (47.2 to 34.5 kg/m2; p < 0.001) decreased post-operatively. There were improvements in CNFD (27.1 to 29.2/mm2; p = 0.005), CNBD (63.4 to 77.8/mm2; p = 0.008), CNFL (20.0 to 20.2/mm2; p = 0.001), NSP (3 to 0/38; p < 0.001) and eGFRcyst-creat (128 to 120 ml/min; p = 0.015) post-bariatric surgery. Changes in (Δ) triglycerides were independently associated with ΔCNFL (β = − 0.53; p = 0.024) and Δsystolic blood pressure (β = 0.62;p = 0.017), and %excess BMI loss (β = − 0.004; p = 0.018) were associated with ΔeGFRcyst-creat. There was no significant change in NDS, VPT, CPT, WPT, NCS, uACR or retinopathy status. Glomerular hyperfiltration resolved in 42% of the 12 patients with this condition pre-operatively. Conclusion Bariatric surgery results in improvements in small nerve fibres and glomerular hyperfiltration in obese people with T2D, which were associated with weight loss, triglycerides and systolic blood pressure, but with no change in retinopathy or uACR at 12 months.

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Section: Introductionmentioning

confidence: 99%

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Adam

Azmi

et al. 2020

OBES SURG

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“…AMSAN, a variant of GBS, is characterized by acute onset of distal weakness, loss of deep tendon reflexes, sensory symptoms, and is confirmed by ENMG [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Rapid and excessive weight loss may cause malnutrition related polyneuropathy [12][13][14][15]. In the first case, BMI decreased from 59.7 kg/m 2 to 40.3 kg/m 2 in six months.…”

Section: Discussionmentioning

confidence: 99%

A new etiology for variant of Guillain-Barré syndrome: bariatric surgery

Şahin

Ateş

Çınar

et al. 2019

The European Research Journal

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Bariatric surgery is an effective treatment for obesity. However, the number of acute or chronic neurological complications after bariatric surgery, including Guillain-Barré syndrome, is increasingly reported. We present here two cases which developed acute motor sensory polyneuropathy a couple months after bariatric surgery which rapidly progressed over the following month. Both patients used received parenteral vitamin B complex replacement after surgery. The first case responded well to intravenous immunoglobulin (IVIg) treatment. However, the second case required plasmapheresis and physical rehabilitation for recovery after IVIg treatment. It is thought that minerals, vitamins, and trace element deficiencies can develop after bariatric surgery. These deficiencies may trigger inflammatory and autoimmune mechanisms and cause acute polyneuropathies. In such cases, it should be kept in mind that immune therapies may be beneficial, as well as vitamins.

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“…Indeed post bariatric surgery neuropathic pain has an incidence of 33% and can greatly affect quality of life. It is important that any nutritional deficiencies, lipid abnormalities and poor glycemic control or indeed neuropathy related to a rapid improvement in glycemic control, so called 'insulin neuritis' are identified early so the patient can be managed effectively [58].…”

Section: Effects On Microvascular Complicationsmentioning

confidence: 99%

The effect of bariatric surgery on obesity and its complications

Azmi¹,

Alam²,

Ammori³

et al. 2015

Diabetes Management

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Obesity has become a worldwide epidemic that is accompanied by a rise in Type 2 diabetes mellitus. Management of obesity is paramount to prevent the associated mortality and morbidity. Several randomized control trials show that bariatric surgery is an effective method for the treatment of obesity and remission of Type 2 diabetes in the short term. Long-term observational studies have further validated the improvements in weight and Type 2 diabetes as well as cardiovascular events and overall mortality. There is an improvement in microvascular outcomes, in particular retinopathy and nephropathy show promising results but further studies are needed to evaluate hard-end points for neuropathy. Bariatric surgery is cost effective with the cost of surgery being offset by future cost benefits. KEYWORDS Practice points• There is a worldwide increase in obesity and Type 2 diabetes mellitus (T2DM).• Obesity is associated with increased mortality and morbidity.• Bariatric Surgery is a cost-effective treatment for obesity and Type 2 diabetes, which in the long-term is associated with an improvement in mortality.• NICE guidelines recommend that all patients with a BMI of 35 or over who have recent-onset T2DM be assessed for bariatric surgery.• The outcome on weight of the different surgical procedures affects the remission rates of T2DM.• Microvascular outcomes show promising results postbariatric surgery, however, these need to be further evaluated particular on neuropathy.• Careful patient selection is important to achieve the best outcomes post bariatric surgery.There is a worldwide rapid increase in obesity prevalence such that it may be described as an epidemic. Obesity has more than doubled since 1980 such that in 2014 more than 1.9 billion adults were overweight and over 600 million were obese [1]. In 2013, 42 million children under the age of 5 years were overweight or obese [1]. The adverse consequences of this are emphasized when one considers that BMI is a powerful predictor of Type 2 diabetes mellitus (T2DM), cardiovascular (CV) morbidity and mortality [2,3]. There are currently 382 million people in the world with diabetes and this is estimated to reach 592 million by 2035 [4]. Indeed despite the emphasis on malnutrition in the developing world, overweight and obesity are linked to more deaths than being underweight.For reprint orders, please contact: reprints@futuremedicine.com

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Postbariatric Surgery Neuropathic Pain (PBSNP): Case Report, Literature Review, and Treatment Options

Cited by 10 publications

References 39 publications

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

A new etiology for variant of Guillain-Barré syndrome: bariatric surgery

The effect of bariatric surgery on obesity and its complications

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