Top

Published in:

01-03-2020 | Sleeve Gastrectomy | Review

Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review

Authors: Camille Sollier, Charles Barsamian, Marion Bretault, Tigran Poghosyan, Gabriel Rahmi, Jean-Marc Chevallier, Jean-Luc Bouillot, Claire Carette, Sébastien Czernichow, Claire Rives-Lange

Published in: Obesity Surgery | Issue 3/2020

Abstract

There is a lack of recommendation regarding exploration and treatment of chronic diarrhea following gastric bypass, while it is a common side effect of this surgery. The electronic databases MEDLINE and EMBASE were searched until July 2018. Of the 553 articles identified, 35 articles were included. Intestinal bacterial overgrowth and pancreatic exocrine insufficiency are the main etiologies of diarrhea following gastric bypass. The diagnostic approach must begin by eliminating infectious causes of diarrhea. Exocrine pancreatic insufficiency can be diagnosed with fecal fat quantification or fecal elastase 1 level evaluation. A positive lactulose breath test confirms suspicion of small intestine bacterial overgrowth. In conclusion, we propose sequential exploration and treatment of the possible etiologies of diarrhea depending on clinical symptoms.

Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34. https://doi.org/10.1111/joim.12012.CrossRefPubMed

Su YH, Lee WJ, Lee Y-C, et al. P-37 Gastrointestinal symptoms after bariatric surgery: a comparison of Roux-en-Y and mini gastric bypass. Surg Obes Relat Dis. 2011;7:384–5. https://doi.org/10.1016/j.soard.2011.04.038.CrossRef

Edholm D, Svensson F, Näslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9:708–13. https://doi.org/10.1016/j.soard.2012.02.011.CrossRefPubMed

Mahawar KK, Jennings N, Brown J, et al. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23:1890–8. https://doi.org/10.1007/s11695-013-1026-8.CrossRefPubMed

Cooper BT. Diarrhoea as a symptom. Clin Gastroenterol. 1985;14:599–613.PubMed

Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18:1287–96. https://doi.org/10.1007/s11695-008-9456-4.CrossRefPubMed

El Labban S, Safadi B, Olabi A. The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: a cross-sectional pilot study. Obes Surg. 2015;25:2393–9. https://doi.org/10.1007/s11695-015-1713-8.CrossRefPubMed

Nickel F, Schmidt L, Bruckner T, et al. Gastrointestinal quality of life improves significantly after sleeve gastrectomy and Roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg. 2017;27:1292–7. https://doi.org/10.1007/s11695-016-2464-x.CrossRefPubMed

Søvik TT, Karlsson J, Aasheim ET, et al. Gastrointestinal function and eating behavior after gastric bypass and duodenal switch. Surg Obes Relat Dis. 2013;9:641–7. https://doi.org/10.1016/j.soard.2012.06.006.CrossRefPubMed

10.

Skogar ML, Sundbom M. Duodenal switch is superior to gastric bypass in patients with super obesity when evaluated with the bariatric analysis and reporting outcome system (BAROS). Obes Surg. 2017;27:2308–16. https://doi.org/10.1007/s11695-017-2680-z.CrossRefPubMedPubMedCentral

11.

Wasserberg N, Hamoui N, Petrone P, et al. Bowel habits after gastric bypass versus the duodenal switch operation. Obes Surg. 2008;18:1563–6. https://doi.org/10.1007/s11695-008-9658-9.CrossRefPubMed

12.

Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11:321–6. https://doi.org/10.1016/j.soard.2014.09.004.CrossRef

13.

Petereit R, Jonaitis L, Kupčinskas L, et al. Gastrointestinal symptoms and eating behavior among morbidly obese patients undergoing Roux-en-Y gastric bypass. Medicina (Kaunas). 2014;50:118–23. https://doi.org/10.1016/j.medici.2014.06.009.CrossRef

14.

Foster A, Laws HL, Gonzalez QH, et al. Gastrointestinal symptomatic outcome after laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg. 2003;7:750–3.CrossRef

15.

Friess H, Böhm J, Müller MW, et al. Maldigestion after total gastrectomy is associated with pancreatic insufficiency. Am J Gastroenterol. 1996;91:341–7.PubMed

16.

Vujasinovic M, Valente R, Thorell A, et al. Pancreatic exocrine insufficiency after bariatric surgery. Nutrients. 2017;9 https://doi.org/10.3390/nu9111241.

17.

Borbély Y, Plebani A, Kröll D, et al. Exocrine pancreatic insufficiency after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12:790–4. https://doi.org/10.1016/j.soard.2015.10.084.CrossRefPubMed

18.

Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24:796–805. https://doi.org/10.1007/s11695-013-1166-x.CrossRefPubMed

19.

Odstrcil EA, Martinez JG, Santa Ana CA, et al. The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass. Am J Clin Nutr. 2010;92:704–13. https://doi.org/10.3945/ajcn.2010.29870.CrossRefPubMed

20.

Hashim A, Paulon E, Ahmed M. PTU-141 bile acid malabsorption: an evaluation of current practice. Gut. 2012;61:A243–3.

21.

Soprani A, Carandina S, Cady J. Severe malnutrition after omega loop gastric bypass (OLGB): surgical management and results. Obes Surg. 2015:S161–1.

22.

Moreland AM, Santa Ana CA, Asplin JR, et al. Steatorrhea and hyperoxaluria in severely obese patients before and after Roux-en-Y gastric bypass. Gastroenterology. 2017;152:1055–1067.e3. https://doi.org/10.1053/j.gastro.2017.01.004.CrossRefPubMed

23.

Ahn LB, Huang CS, Forse RA, et al. Crohn’s disease after gastric bypass surgery for morbid obesity: is there an association? Inflamm Bowel Dis. 2005;11:622–4.CrossRef

24.

Chan WW, Thompson CC, Lautz DB, Burakoff R. Risk of small intestinal bacterial overgrowth in Roux-en-Y gastric bypass. Gastroenterology. 2011;140: S–1057.

25.

Machado JDC, Campos CS, Lopes Dah Silva C, et al. Intestinal bacterial overgrowth after Roux-en-Y gastric bypass. Obes Surg. 2008;18:139–43. https://doi.org/10.1007/s11695-007-9365-y.CrossRefPubMed

26.

Sabate J-M, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27:599–605. https://doi.org/10.1007/s11695-016-2343-5.CrossRefPubMed

27.

Krajicek EJ, Hansel SL. Small intestinal bacterial overgrowth: a primary care review. Mayo Clin Proc. 2016;91:1828–33. https://doi.org/10.1016/j.mayocp.2016.07.025.CrossRefPubMed

28.

Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6:583–90. https://doi.org/10.1038/nrgastro.2009.148.CrossRefPubMed

29.

van Beek AP, Emous M, Laville M, et al. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017;18:68–85. https://doi.org/10.1111/obr.12467.CrossRefPubMed

30.

Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of clostridium difficile in adults: a systematic review. JAMA. 2015;313:398–408. https://doi.org/10.1001/jama.2014.17103.CrossRefPubMedPubMedCentral

31.

DuPont HL. Persistent diarrhea: a clinical review. Jama. 2016;315:2712–23.CrossRef

32.

Janczewska I, Nekzada Q, Kapraali M. Crohn’s disease after gastric bypass surgery. BMJ Case Rep 2011;2011. doi:https://doi.org/10.1136/bcr.07.2010.3168

33.

Dodell GB, Albu JB, Attia L, et al. The bariatric surgery patient: lost to follow-up; from morbid obesity to severe malnutrition. Endocr Pract. 2012;18:e21–5. https://doi.org/10.4158/EP11200.CR.CrossRefPubMedPubMedCentral

34.

Mahoney NA, El Mourabet M, Weyant K, Regueiro M, Baidoo L, Barrie A, et al. Bariatric surgery and inflammatory bowel disease. Gastroenterology. 2011;140: S–792.

35.

Shoar S, Hoseini SS, Naderan M, et al. Bariatric surgery in morbidly obese patients with inflammatory bowel disease: a systematic review. Surg Obes Relat Dis. 2017;13:652–9.CrossRef

36.

Saba J, Rodriguez L, Reyes E, Isla O, Munoz J, Munoz S. Diabetic autonomic neuropathy of the gastrointestinal tract and bariatric surgery: a two-case report and literature review. Obes Surg; 2011. pp. 1086–1087.

37.

Green PH, Jabri B. Coeliac disease. Lancet. 2003;362:383–91.CrossRef

38.

Raab H. Lactose intolerance-is it a problem after obesity surgery. Obes Surg. 2011:1036–6.

39.

Rutledge R. The first report of gluten sensitivity as a common cause of significant gastrointestinal symptoms after mini-gastric bypass. Obes Surg. 2011:1061–1.

40.

Lee CW, Kelly JJ, Wassef WY. Complications of bariatric surgery. Curr Opin Gastroenterol. 2007;23:636–43. https://doi.org/10.1097/MOG.0b013e3282f094b5.CrossRefPubMed

41.

Sima E, Hedberg J, Sundbom M. Gastrointestinal symptoms, weight loss and patient satisfaction 5 years after gastric bypass: a study of three techniques for the gastrojejunal anastomosis. Surg Endosc. 2016;30:1553–8. https://doi.org/10.1007/s00464-015-4374-8.CrossRefPubMed

42.

Borbély YM, Osterwalder A, Kröll D, et al. Diarrhea after bariatric procedures: diagnosis and therapy. World J Gastroenterol. 2017;23:4689–700. https://doi.org/10.3748/wjg.v23.i26.4689.CrossRefPubMedPubMedCentral

43.

Risstad H, Svanevik M, Kristinsson JA, et al. Standard vs distal Roux-en-Y gastric bypass in patients with body mass index 50 to 60: a double-blind, randomized clinical trial. JAMA Surg. 2016;151:1146–55. https://doi.org/10.1001/jamasurg.2016.2798.CrossRefPubMed

44.

Ghiassi S, Higa K, Chang S, et al. Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome: 3-year follow-up and evolution of technique to reduce nutritional complications. Surg Obes Relat Dis. 2018;14:554–61. https://doi.org/10.1016/j.soard.2018.01.004.CrossRefPubMed

45.

Arman GA, Himpens J, Bolckmans R, et al. Medium-term outcomes after rReversal of Roux-en-Y gastric bypass. Obes Surg. 2018;28:781–90. https://doi.org/10.1007/s11695-017-2928-7.CrossRefPubMed

46.

Poghosyan T, Caille C, Moszkowicz D, et al. Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass. Surg Obes Relat Dis. 2017;13:988–94. https://doi.org/10.1016/j.soard.2016.12.003.CrossRefPubMed

47.

Shoar S, Poliakin L, Rubenstein R, et al. Single-anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety. Obes Surg. 2018;28:104–13. https://doi.org/10.1007/s11695-017-2838-8.CrossRefPubMed

48.

Hegyi J, Schwartz RA, Hegyi V. Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol. 2004;43:1–5.CrossRef

49.

Levenbergh L, Marot J-C, Wieers G. Pellagra secondary to bariatric surgery. Acta Clinica Belgica. 2017:46–6.

50.

Jampala N, Kachru S, Leland W, et al. Tu2031 rare case of pellagra in a patient after Roux en-Y gastric bypass. Gastroenterology. 2016;150:S1010–1.CrossRef

51.

Ashourian N, Mousdicas N. Images in clinical medicine. Pellagra-like dermatitis. N Engl J Med. 2006;354:1614. https://doi.org/10.1056/NEJMicm050641.CrossRefPubMed

52.

Roberson EN, Gould JC, Wald A. Urinary and fecal incontinence after bariatric surgery. Dig Dis Sci. 2010;55:2606–13. https://doi.org/10.1007/s10620-010-1190-9.CrossRefPubMed

53.

Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019;393:1299–309. https://doi.org/10.1016/S0140-6736(19)30475-1.CrossRefPubMed

54.

Hussain A, Van den Bossche M, Kerrigan DD, et al. Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group. Int J Surg. 2019;69:13–8. https://doi.org/10.1016/j.ijsu.2019.07.003.CrossRefPubMed

Title: Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review
Authors: Camille Sollier
Charles Barsamian
Marion Bretault
Tigran Poghosyan
Gabriel Rahmi
Jean-Marc Chevallier
Jean-Luc Bouillot
Claire Carette
Sébastien Czernichow
Claire Rives-Lange
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Sleeve Gastrectomy
Chronic Inflammatory Bowel Disease
Bariatric Surgery
Bariatric Surgery
Diarrhea
Diarrhea
Published in: Obesity Surgery / Issue 3/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-019-04253-0

At a glance: The STEP trials

Springer Medicine

Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2020

Renal Function 1 Year After Bariatric Surgery: Influence of Roux-en-Y Gastric Bypass and Identification of Pre-Operative Predictors of Improvement

A Longitudinal Analysis of Wait Times for Bariatric Surgery in a Publicly Funded, Regionalized Bariatric Care System

Is Bariatric Surgery Safe and Effective in Patients with Inflammatory Bowel Disease?

Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity

Abdominoplasty: Pitfalls and Prospects

The First Study Evaluating Effectiveness and Safety of the Endoscopic Sleeve Gastroplasty in HIV Patients