Preventing Wernicke Encephalopathy After Bariatric Surgery

Oudman, Erik; Wijnia, Jan W.; Dam, Mirjam van; Biter, L. Ulas; Postma, Albert

doi:10.1007/s11695-018-3262-4

Cited by 130 publications

(133 citation statements)

References 104 publications

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“…A full triad was present in eight cases. This relative occurrence of WE cases presenting with a full triad following AN seems to be higher than that seen earlier in alcoholics with WE (16%) or in patients who developed WE after bariatric surgery (54.2%) . We elaborate on the implications of this finding in our discussion.…”

Section: Resultsmentioning

confidence: 92%

“…AN has the highest mortality rate of any mental disorder, with a general estimate of 5.9% . Rapidly losing weight and malnutrition can cause severe somatic complications, such as WE . The present review has highlighted the signs and symptoms of WE in AN to increase the clinician's suspicion for this neuropsychiatric condition, and to recommend treatment options.…”

Section: Discussionmentioning

confidence: 94%

“…38 Rapidly losing weight and malnutrition can cause severe somatic complications, such as WE. 31 The present review has highlighted the signs and symptoms of WE in AN to increase the clinician's suspicion for this neuropsychiatric condition, and to recommend treatment options. The results reviewed here show that WE following AN is a relatively rare condition that presents itself with the classic triad of ataxia, ocular signs, and mental status change in eight of the 12 reviewed cases.…”

Section: Discussionmentioning

confidence: 99%

“…Usually deliriums with altered states of consciousness are common in WE, 35 although mental status change without altered consciousness has been reported in some cases, 36 and some evidence suggests that a younger age can specifically protect against alterations in consciousness. 31 It is therefore relevant to review a broad range of mental status problems as a possible symptom of WE in AN.…”

Section: Signs and Symptomsmentioning

confidence: 99%

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Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Oudman

Wijnia

Oey

et al. 2018

Psychiatry Clin Neurosci

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Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Our aim was to review the signs and symptoms of WE in patients with AN. We searched MEDLINE, EMBASE, Scopus, and PiCarta on all case descriptions of WE following AN. All case descriptions of WE in AN, irrespective of language, were included. Twelve WE cases were reviewed, suggesting that WE following AN is still a relatively rare neuropsychiatric disorder. WE is characterized by a triad of: mental status change, ocular signs, and ataxia. In alcoholism, this triad is present in 16% of cases, but eight out of 12 AN cases presented themselves with a full triad of symptomatology. Importantly, patients often had a more complex triad than has been previously described, involving vertigo, diplopia, and the consequences of refeeding syndrome. The development of a full triad and additional symptomatology suggests a late recognition of signs and symptoms of WE in AN. A complicating factor is the overlap between symptoms of thiamine deficiency and the symptoms of WE. Specifically, patients who show rapid weight loss are vulnerable for the development of WE. Eating disorders, such as AN, can lead to WE. Prophylactic thiamine checks and treatment in patients with AN are relevant, and in case of suspicion of WE, adequate parenteral thiamine supplementation is necessary.

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Section: Resultsmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Signs and Symptomsmentioning

confidence: 99%

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Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Oudman

Wijnia

Oey

et al. 2018

Psychiatry Clin Neurosci

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“…Recent guidelines suggest a preventive thiamine supplementation for all patients undergoing bariatric surgery [6] only 10-20% of Wernicke's encephalopathy shows the typical clinical trial of altered mental state, cerebellar dysfunction and ophthalmoplegia even serum thiamine level may be normal in some cases [7]. Atypical neurologic features, including myoclonus, seizures, hearing loss, papilledema, paresis, and psychosis were reported [8].…”

Section: Wernicke's Encephalopathy and Polyradiculoneurpathy After Bamentioning

confidence: 99%

Wernicke’s Encephalopathy and Polyradiculoneurpathy after Bariatric Surgery: A Case Report

Belal¹,

Al-Malt²,

Nosair³

et al. 2018

J Neurol Exp Neurosci

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Nutritional deficiency after bariatric surgery has its consequence on nervous system. Thiamine reduction occurs weeks after surgery, which results in dysfunction of both central and peripheral nervous system. We report a case of a young female patient who was subjected to bariatric surgery four months ago, then she developed ascending flaccid paresis due to polyradiculoneuropathy, facial diplegia and respiratory distress; these manifestations were preceded by ataxia and disturbed conscious level. After an initial diagnosis of Miller Fisher variant of Guillain-Barré Syndrome, the patient received two sessions of plasma exchange, then we revised our diagnosis based on clinical signs and brain imaging which was suggestive of Wernicke's encephalopathy. Consequently, we started thiamine infusion which resulted in improvement of both power and cognitive functions. Upon this case, we can deduce two key points: first, the importance of good nutritional support after bariatric surgery; second, the importance of considering nutritional deficiency as a differential diagnosis when facing any case with prior history of bariatric surgery.

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Abdominal Pain After Roux-en-Y Gastric Bypass

Fry,

Finks

2023

JAMA Surg

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ImportanceRoux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care.ObservationsGiven the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted.Conclusions and RelevanceThe etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.

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Preventing Wernicke Encephalopathy After Bariatric Surgery

Cited by 130 publications

References 104 publications

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Wernicke’s Encephalopathy and Polyradiculoneurpathy after Bariatric Surgery: A Case Report

Abdominal Pain After Roux-en-Y Gastric Bypass

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