Hope N Moore1, Alexis R Chirco2, Trevor Plescia1, Shushmita Ahmed1, Barbara Jachniewicz1, Ganesh Rajasekar1, Mohamed R Ali1, Victoria Lyo3,4. 1. Department of Surgery, University of California Davis Health, Sacramento, CA, USA. 2. University of California, Davis, CA, USA. 3. Department of Surgery, University of California Davis Health, Sacramento, CA, USA. vlyo@ucdavis.edu. 4. UC Davis Medical Center, 2335 Stockton Blvd., NAOB 6113, Sacramento, CA, 95817, USA. vlyo@ucdavis.edu.
Abstract
INTRODUCTION: Gastrointestinal symptoms such as diarrhea, bloating, abdominal pain, and nausea are common after bariatric surgery (BS) and can lead to significant morbidity. While many diagnoses can explain these symptoms, post-bariatric exocrine pancreatic insufficiency (EPI) is becoming increasingly recognized as contributor to gastrointestinal symptoms. The frequency and outcomes of EPI after BS are not well understood. We investigated the prevalence and outcomes of EPI over 18 years at a tertiary bariatric referral center. METHODS: A retrospective review of patients who underwent primary or revisional BS from 2002 to 2020 was performed. Patients were included if they were suspected of having EPI or underwent fecal elastase testing (FE-1). EPI diagnosis was defined as positive FE-1 testing or improvement with empiric pancreatic enzyme replacement therapy (PERT). RESULTS: EPI was suspected in 261 patients, and 190 were tested via FE-1 (89.5%) or empirically treated (10.5%). EPI was diagnosed in 79 (41.6%) patients and was associated with older age and lower BMI. Therapeutic PERT was given to 65 patients diagnosed with EPI, and 56 (86.2%) patients reported improved symptoms. Patients who underwent RYGB and BPD-DS were more likely to have EPI than those after SG (47.9% and 70.0% vs 17.4%, p < 0.01). EPI diagnosis was associated with a history chronic pancreatitis. While diarrhea and abdominal pain were the most common symptoms prompting FE-1 testing, no symptoms were significantly associated with EPI. EPI was also associated with abnormal fecal fat results and treatment with bile acid sequestrants, but not small intestinal bacterial overgrowth. CONCLUSION: This study highlights that exocrine pancreatic insufficiency can account to for previously unexplained GI complaints after bariatric surgery. Therefore, bariatric surgery programs should consider this diagnosis in symptomatic patients, especially following RYGB and BPD-DS. Further work to define patient factors that should prompt evaluation, optimal treatment, and prevention is necessary.
INTRODUCTION: Gastrointestinal symptoms such as diarrhea, bloating, abdominal pain, and nausea are common after bariatric surgery (BS) and can lead to significant morbidity. While many diagnoses can explain these symptoms, post-bariatric exocrine pancreatic insufficiency (EPI) is becoming increasingly recognized as contributor to gastrointestinal symptoms. The frequency and outcomes of EPI after BS are not well understood. We investigated the prevalence and outcomes of EPI over 18 years at a tertiary bariatric referral center. METHODS: A retrospective review of patients who underwent primary or revisional BS from 2002 to 2020 was performed. Patients were included if they were suspected of having EPI or underwent fecal elastase testing (FE-1). EPI diagnosis was defined as positive FE-1 testing or improvement with empiric pancreatic enzyme replacement therapy (PERT). RESULTS: EPI was suspected in 261 patients, and 190 were tested via FE-1 (89.5%) or empirically treated (10.5%). EPI was diagnosed in 79 (41.6%) patients and was associated with older age and lower BMI. Therapeutic PERT was given to 65 patients diagnosed with EPI, and 56 (86.2%) patients reported improved symptoms. Patients who underwent RYGB and BPD-DS were more likely to have EPI than those after SG (47.9% and 70.0% vs 17.4%, p < 0.01). EPI diagnosis was associated with a history chronic pancreatitis. While diarrhea and abdominal pain were the most common symptoms prompting FE-1 testing, no symptoms were significantly associated with EPI. EPI was also associated with abnormal fecal fat results and treatment with bile acid sequestrants, but not small intestinal bacterial overgrowth. CONCLUSION: This study highlights that exocrine pancreatic insufficiency can account to for previously unexplained GI complaints after bariatric surgery. Therefore, bariatric surgery programs should consider this diagnosis in symptomatic patients, especially following RYGB and BPD-DS. Further work to define patient factors that should prompt evaluation, optimal treatment, and prevention is necessary.
Authors: David Edholm; Felicity Svensson; Ingmar Näslund; F Anders Karlsson; Eva Rask; Magnus Sundbom Journal: Surg Obes Relat Dis Date: 2012-03-23 Impact factor: 4.734
Authors: Lindel C Dewberry; Jane C Khoury; Shelley Ehrlich; Todd M Jenkins; Andrew J Beamish; Heidi J Kalkwarf; Stavra A Xanthakos; Thomas Inge Journal: J Pediatr Surg Date: 2019-02-28 Impact factor: 2.545
Authors: Naveen Ballem; Kishore Yellumahanthi; Matthew Wolfe; Mary M Wesley; Ronald H Clements Journal: Surg Obes Relat Dis Date: 2009-01-23 Impact factor: 4.734
Authors: Torgeir T Søvik; Jan Karlsson; Erlend T Aasheim; Morten W Fagerland; Sofia Björkman; My Engström; Jon Kristinsson; Torsten Olbers; Tom Mala Journal: Surg Obes Relat Dis Date: 2012-06-28 Impact factor: 4.734
Authors: Dale S Bond; J Graham Thomas; Daniel B Jones; Leah M Schumacher; Jennifer Webster; E Whitney Evans; Andrea B Goldschmidt; Sivamainthan Vithiananthan Journal: Surg Obes Relat Dis Date: 2020-11-24 Impact factor: 3.709