Abstract
Roux-en-Y gastric bypass (RYGB) is a widely performed and well-established metabolic and bariatric surgery (MBS) procedure around the world based on its high efficacy and low complication profile when offered to appropriately selected candidates. However, it is still associated with chronic abdominal pain confounded by non-specific symptoms and signs that many times lead to a delay in diagnosis or excessive and unnecessary testing that may put patients at risk for long-term complications and adverse events. Among the most important causes of chronic abdominal pain after RYGB are marginal ulcers, intussusception, internal hernias, bile reflux gastritis, dumping syndrome, small intestinal bacterial overgrowth (SIBO), candy cane syndrome, biliary pathology, vascular etiologies, and gastroesophageal reflux disease (GERD). A comprehensive literature review based on the highest-level available published manuscripts has been conducted with the goal of providing the readers and members from the American Society for Metabolic and Bariatric Surgery (ASMBS) with a practical algorithm to diagnose and treat chronic abdominal pain after RYGB. An organized approach that promotes early diagnosis and cause-specific management in a multidisciplinary team environment led by metabolic and bariatric surgeons is advised and encouraged. This literature review by the members of the Clinical Issues Committee (CIC) of ASMBS introduces available high-level evidence to allow our members to achieve early diagnosis of the etiologies of chronic abdominal pain and the expedited therapeutic maneuvers to address them and improve quality of life while increasing patient survival.
Authors
- Rodolfo J. Oviedo, MD FACS FRCS FICS FASMBS DABS-FPDMBS
- Maria S. Altieri, MD MS
- Laura Aylward, PhD
- Ambar Banerjee, MD FACS FASMBS DABS-FPDMBS
- Sabrena F. Noria, MD PhD FACS FASMBS
- Christina M. Seeger, CPhT MLS
- Faiz Shariff, MD FACS FASMBS
- C. Joe Northup, MD FACS FASMBS
- R. Wesley Vosburg, MD FACS FASMBS