Constipation in Patients with Thiamine Deficiency after Roux-en-Y Gastric Bypass Surgery

Shah, Hiral; Bal, Bikram; Finelli, Frederick C.; Koch, Timothy R.

doi:10.1159/000353245

Cited by 27 publications

(25 citation statements)

References 20 publications

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“…Chaves et al 46 reported that encephalopathy due to thiamin deficiency occurred in only 0.18% (of 1663 patients) after BPD 39 . More recently, Shah et al 47 prospectively reported symptomatic thiamin deficiency in 18% of post‐RYGB patients. The risk for thiamin deficiency may be more striking in those with alcohol abuse after bariatric surgery.…”

Section: Specific Micronutrient Deficienciesmentioning

confidence: 99%

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

et al. 2017

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Obesity has become a worldwide epidemic with a disproportionate increase in grade III obesity. Bariatric surgery offers an attractive option for sustained weight loss compared with traditional methods such as exercise and diet. Micronutrient deficiencies are common and clinically significant after bariatric surgery. These deficiencies are related to a combination of patient and surgical variables. A thorough understanding of specific micronutrient deficiencies is necessary for early recognition and optimal management. The purpose of this review is to describe indications, outcomes, and types of bariatric procedures, risk factors, and mechanisms for micronutrient deficiencies, as well as outline specific vitamin and trace element deficiencies after bariatric surgery.

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Section: Specific Micronutrient Deficienciesmentioning

confidence: 99%

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

et al. 2017

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“…Symptoms of nausea, vomiting and dysphagia have been observed in a significant proportion of individuals with thiamine deficiency[22,23]. Thiamine deficiency is a known complication of bariatric surgery, and in a previous prospective study we found an 18% prevalence of thiamine deficiency in patients after gastric bypass surgery[24]. In parallel work, Van Rutte et al[25] reported a 5.5% prevalence of thiamine deficiency one year after VSG, while Saif et al[26] reported thiamine deficiency in 14.3% and 30.8% of patients 3 years and then 5 years after VSG.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

Nath¹,

Yewale²,

Tran³

et al. 2016

WJG

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AIMTo evaluate the risks of medical conditions, evaluate gastric sleeve narrowing, and assess hydrostatic balloon dilatation to treat dysphagia after vertical sleeve gastrectomy (VSG).METHODSVSG is being performed more frequently worldwide as a treatment for medically-complicated obesity, and dysphagia is common post-operatively. We hypothesize that post-operative dysphagia is related to underlying medical conditions or narrowing of the gastric sleeve. This is a retrospective, single institution study of consecutive patients who underwent sleeve gastrectomy from 2013 to 2015. Patients with previous bariatric procedures were excluded. Narrowing of a gastric sleeve includes: inability to pass a 9.6 mm gastroscope due to stenosis or sharp angulation or spiral hindering its passage.RESULTSOf 400 consecutive patients, 352 are included; the prevalence of dysphagia is 22.7%; 33 patients (9.3%) have narrowing of the sleeve with 25 (7.1%) having sharp angulation or a spiral while 8 (2.3%) have a stenosis. All 33 patients underwent balloon dilatation of the gastric sleeve and dysphagia resolved in 13 patients (39%); 10 patients (30%) noted resolution of dysphagia after two additional dilatations. In a multivariate model, medical conditions associated with post-operative dysphagia include diabetes mellitus, symptoms of esophageal reflux, a low whole blood thiamine level, hypothyroidism, use of non-steroidal anti-inflammatory drugs, and use of opioids.CONCLUSIONNarrowing of the gastric sleeve and gastric sleeve stenosis are common after VSG. Endoscopic balloon dilatations of the gastric sleeve resolves dysphagia in 69% of patients.

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“…Gastroenterolic causes of TD include slow gastric emptying, nausea, vomiting, jejunal dilatation, and/or megacolon 54 . In addition, constipation may also be a sign and symptom of TD 73 . Small‐bowel bacterial overgrowth (SBBO) can also result in low thiamin levels 74 .…”

Section: Deficiency: Signs and Symptomsmentioning

confidence: 99%

Thiamin in Clinical Practice

Frank

2015

J Parenter Enteral Nutr

132

150

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Thiamin is a water-soluble vitamin also known as vitamin B1. Its biologically active form, thiamin pyrophosphate (TPP), is a cofactor in macronutrient metabolism. In addition to its coenzyme roles, TPP plays a role in nerve structure and function as well as brain metabolism. Signs and symptoms of thiamin deficiency (TD) include lactic acidosis, peripheral neuropathy, ataxia, and ocular changes (eg, nystagmus). More advanced symptoms include confabulation and memory loss and/or psychosis, resulting in Wernicke's encephalopathy and/or Wernicke's Korsakoff syndrome, respectively. The nutrition support clinician should be aware of patients who may be at risk for TD. Risk factors include those patients with malnutrition due to 1 or more nutrition-related etiologies: decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption. Clinical scenarios such as unexplained heart failure or lactic acidosis, renal failure with dialysis, alcoholism, starvation, hyperemesis gravidarum, or bariatric surgery may increase the risk for TD. Patients who are critically ill and require nutrition support may also be at risk for TD, especially those who are given intravenous dextrose void of thiamin repletion. Furthermore, understanding thiamin's role as a potential therapeutic agent for diabetes, some inborn errors of metabolism, and neurodegenerative diseases warrants further research. This tutorial describes the absorption, digestion, and metabolism of thiamin. Issues pertaining to thiamin in clinical practice will be described, and evidence-based practice suggestions for the prevention and treatment of TD will be discussed.

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Constipation in Patients with Thiamine Deficiency after Roux-en-Y Gastric Bypass Surgery

Cited by 27 publications

References 20 publications

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention

Thiamin in Clinical Practice

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