Marginal Ulcer After Gastric Bypass: A Prospective 3-Year Study of 173 Patients

Ja, Sapala; Mh, Wood; Ma, Sapala; Tm, Flake

doi:10.1381/096089298765554061

Cited by 242 publications

(129 citation statements)

References 30 publications

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“…Barroso et al (3) reported, in endoscopic tests performed 2 to 6 months after the RYGBP, a 4.7% rate of ulcers in the anastomosis, associated with severe symptoms. Sapala et al (20) observed no ulcer 1 year after RYGBP, and only one case 3 years later. These reports, in addition to our findings, may indicate a progressively reduced incidence of ulcers following the ischemic suture period regression.…”

Section: Discussionmentioning

confidence: 94%

“…Some of the complications start in the gastrointestinal tube within the first post-surgical months, causing symptoms like nausea, vomiting, epigastric pain, abdominal pain and bleeding, which may be due to peptic disorders, such as ulcers and erosions (1,10) . The incidence of ulcer in the anastomosis (GJU) is variable in the literature, ranging from 1% to 16% after the RYGBP (3,7,20) . Ulcers may be caused by the peptic action of the acid juice from the gastric pouch acting on the small bowel not alcalinized by biliopancreatic juice (11) .…”

Section: Introductionmentioning

confidence: 99%

“…Ulcers may be caused by the peptic action of the acid juice from the gastric pouch acting on the small bowel not alcalinized by biliopancreatic juice (11) . During the immediate post-surgical period factors like ischemia caused by the sutures, foreign body reaction to the presence of synthesis material, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) may play a role (7,20) . Considering all these possibilities, bariatric surgeons, trying to reduce such complications, usually prescribe proton pumb inhibitors (PPIs) during the post-surgical period.…”

Section: Introductionmentioning

confidence: 99%

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Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Garrido¹,

Rossi²,

Lima³

et al. 2010

Arq. Gastroenterol.

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-Context -Causal factors of gastrojejunal ulcers after Roux-en-Y gastric bypass include peptic acid secretion from the gastric pouch. Esomeprazole is a potent inhibitor of acid secretion. Objective -To assess the occurrence of dyspepsia and gastrojejunal ulcers within the first 2 months after Roux-en-Y gastric bypass during the use of esomeprazole. Methods -One hundred eighteen morbid obese subjects were submitted to Roux-en-Y gastric bypass. Preoperative upper gastrointestinal tract endoscopy was negative for H. pylori. All subjects received esomeprazole for 60 days after surgery. Results -Two weeks after surgery only 13 mild symptoms were reported. After 2 months, 17 also moderate complaints were registered. Endoscopy around the 60th day showed esophagitis in 10 (8.5%), hiatal hernia in 2 (1.7%), foreign body in the anastomotic line in 12 (10.2%) and gastrojejunal ulcers was observed in 9 (7.6%) subjects, 2 of which had a suture material or metallic staple granuloma in the gastrojejunostomy. Ten subjects took nonsteroidal anti-inflammatory drugs at least once during study, but none of them developed ulcer. None of the subjects with ulcer had dyspeptic symptoms. Conclusion -The incidence of ulcer in the gastrojejunal anastomosis within the first 2 months following Rouxen-Y gastric bypass under proton pump inhibitors is considerable. It was not related to the use of non-steroidal anti-inflammatory drugs, highlighting the possibility of ischemia and foreign body as causal factors. The ulcers were asymptomatic, and all post-surgical dyspeptic symptoms were moderate in severity.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Garrido¹,

Rossi²,

Lima³

et al. 2010

Arq. Gastroenterol.

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“…65,66 Stomach ulcers may develop over the short term, possibly associated with technical problems at the intervention site. 67 They are usually located in the damaged intestinal mucosa, unable to withstand acidity; they may also be located near the anastomosis.…”

Section: Gastric Antisecretory Agentsmentioning

confidence: 99%

Medication and nutritional supplement use before and after bariatric surgery

Backes

Lopes²,

Tetelbom

et al. 2016

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Bariatric surgery has been an effective alternative treatment for morbid obesity and has resulted in decreased mortality, better control over comorbidities and reduced use of drugs. The objective of this study was to analyze the impact of bariatric surgery on medication drug and nutritional supplement use. DESIGN AND SETTING: Longitudinal study of before-and-after type, on 69 morbidly obese patients in a public hospital in Porto Alegre. METHODS: Through interviews, the presence of comorbidities and use of drugs with and without prescription were evaluated. RESULTS: Among the 69 patients interviewed, 85.5% had comorbidities in the preoperative period, with an average of 2.3 (± 1.5) per patient. The main comorbidities reported were hypertension, diabetes and dyslipidemia. 84.1% of the patients were using prescribed drugs in the preoperative period. The mean drug use per patient was 4.8, which decreased to 4.4 after the procedure. The surgery enabled significant reduction in use of most antidiabetic (84%), antilipemic (77%) and antihypertensive drugs (49.5%). On the other hand, there was a significant increase in use of multivitamins and drugs for disorders of the gastrointestinal tract. The dosages of most of the drugs that continued to be prescribed after surgery were decreased, but not significantly. CONCLUSION: After bariatric surgery, there were increases in the use of vitamins, gastric antisecretory drugs and antianemic drugs. Nevertheless, there was an overall reduction in drug use during this period, caused by suspension of drugs or dose reduction. RESUMO CONTEXTO E OBJETIVO:A cirurgia bariátrica tem sido uma alternativa efetiva de tratamento para a obesidade mórbida, resultando na diminuição da mortalidade, melhor controle das comorbidades e redução no uso de medicamentos. O objetivo deste estudo foi analisar o impacto da cirurgia bariátrica sobre a utilização de medicamentos e suplementos nutricionais. TIPO DE ESTUDO E LOCAL: Estudo longitudinal do tipo antes e depois com 69 pacientes obesos mórbi-dos em um hospital público de Porto Alegre. MÉTODOS: Nas entrevistas, foram avaliados a presença de comorbidades e o uso de medicamentos com e sem prescrição médica. RESULTADOS: De 69 pacientes entrevistados, 85,5% apresentaram comorbidades no período pré-cirúrgi-co, média de 2,3 (± 1,5) por paciente. As principais comorbidades relatadas foram hipertensão, diabetes e dislipidemias. 84,1% dos pacientes estavam em uso de medicamentos sob prescrição médica, no período pré-cirúrgico. A média de uso de medicamentos por paciente foi de 4,8, reduzindo para 4,4 após o procedimento. A cirurgia proporcionou diminuição significativa do uso da maioria dos antidiabéticos (84%), antilipêmicos (77%) e anti-hipertensivos (49,5%). Por outro lado, observou-se aumento significativo na utilização de multivitamínicos e medicamentos para desordens do trato gastrointestinal. A maior parte dos medicamentos que continuaram sendo prescritos após a cirurgia teve sua dose reduzida, no entanto, esta redução nã...

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“…Weight loss was 28-76 kg after 2 y, [79][80][81][82][83][84][85][86][87][88][89] 17-73 kg after 3 y, [79][80][81][86][87][88][89] and 20 kg after 8 y in one study [82][83][84] based on a completers method of analysis. No study reported the proportion of subjects with Z5% weight loss, although this was probably high given the absolute weight loss with surgical therapy.…”

Section: Surgical Therapymentioning

confidence: 99%

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

et al. 2005

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BACKGROUND: Obesity is a common health problem that requires a long-term care approach. We systematically reviewed long-term (Z2 y) studies investigating dietary/lifestyle, pharmacologic, and surgical weight loss methods to assess (1) weight loss efficacy, defined by absolute weight loss and the proportion of subjects with Z5% weight loss, (2) effects of weight loss on cardiovascular risk factors, and (3) applicability of findings from studies to everyday clinical practice. METHODS: The MEDLINE, HealthSTAR, and the Cochrane Controlled Trials databases were searched for studies investigating the long-term efficacy of weight loss methods in overweight and obese adults. Data were extracted for (i) weight loss after 1 y (pharmacologic studies only), 2 y, 3 y, and 4 y, (ii) proportion of subjects with Z5% weight loss at the end of follow-up, and (iii) changes (end-of follow-up minus baseline values) in blood lipids, fasting blood glucose, and systolic and diastolic blood pressure. RESULTS: Dietary/lifestyle therapy provides o5 kg weight loss after 2-4 y, pharmacologic therapy provides 5-10 kg weight loss after 1-2 y, and surgical therapy provides 25-75 kg weight loss after 2-4 y. Weight loss of Z5% baseline weight is not consistently associated with improvements in cardiovascular risk factors and these benefits appear to be intervention specific and occur mainly in people with concomitant cardiovascular risk factors. Weight loss studies have methodologic limitations that restrict the applicability of findings to unselected obese people assessed in everyday clinical practice. These limitations include an inadequate study duration, large proportions of subjects lost to follow-up, a lack of an appropriate usual care group, and a lack of reporting of outcomes in high-risk subgroups. CONCLUSIONS: Dietary/lifestyle and pharmacologic weight loss interventions provide modest weight loss, and may improve markers of cardiovascular risk factors although these benefits occur mainly in patients with cardiovascular risks. Studies investigating weight loss have methodologic limitations that restrict the applicability of findings to obese patients assessed in clinical practice.

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Marginal Ulcer After Gastric Bypass: A Prospective 3-Year Study of 173 Patients

Abstract: This study reviews the etiology, diagnosis, and treatment of MU in the RYGB patient and offers specific recommendations to reduce its occurrence. It also confirms a preliminary impression that NTGB is an effective operation in preventing MU formation.

Cited by 242 publications

References 30 publications

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study

Medication and nutritional supplement use before and after bariatric surgery

Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice

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