PMID- 28799115
OWN - NLM
STAT- MEDLINE
DCOM- 20180822
LR  - 20191008
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Print)
IS  - 0930-2794 (Linking)
VI  - 31
IP  - 12
DP  - 2017 Dec
TI  - Remnant gastropathy due to bile reflux after Roux-en-Y gastric bypass: a unique 
      cause of abdominal pain and successful treatment with ursodiol.
PG  - 5399-5402
LID - 10.1007/s00464-017-5621-y [doi]
AB  - BACKGROUND: Chronic abdominal pain can occur after Roux-en-Y gastric bypass 
      (RYGB), and can remain unexplained despite extensive investigation. Bile can pool 
      in the gastric remnant and create a bile reflux gastropathy. The aim of this 
      study was to assess gastric remnant findings in patients with RYGB and chronic 
      abdominal pain of unclear etiology, and to determine the effectiveness of 
      ursodiol therapy for patients with confirmed remnant gastropathy. METHODS: All 
      consecutive patients with RYGB and a diagnosis of chronic abdominal pain, and a 
      negative diagnostic workup (including physical examination, routine laboratory 
      work, cross-sectional imaging, and standard upper endoscopy), who underwent 
      device-assisted enteroscopy for evaluation of the gastric remnant, were included. 
      Pathology reports, treatments, and clinical follow-up were recorded. RESULTS: 28 
      post-RYGB patients (all female) with chronic abdominal pain and negative 
      evaluation were included. Pooling of bile with gastric erythema was noted in 
      22/28 patients. All 22 patients with endoscopic erythema had pathology consistent 
      with bile reflux chemical gastropathy. Of these patients, 12 were started on a 
      proton pump inhibitor (PPI) alone, and 10 were started on ursodiol. Of the 
      ursodiol group, 8/10 (80%) patients reported substantial improvement or 
      resolution of abdominal pain at clinical follow-up. All three ursodiol patients 
      with repeat endoscopic examination of the gastric remnant had endoscopic and 
      histologic resolution of gastropathy. Of the PPI patients, 1/12 reported 
      improvement in abdominal pain at clinical follow-up (p = 0.002), and both 
      patients with repeat endoscopic examination of the gastric remnant had persistent 
      remnant gastropathy. CONCLUSIONS: Roux-en-Y gastric bypass patients with 
      unexplained chronic pain, and biopsy-confirmed chemical gastropathy, had a 
      significantly higher rate of abdominal pain resolution with ursodiol treatment 
      compared to PPI. Remnant gastropathy due to bile reflux is a treatable cause of 
      chronic abdominal pain in RYGB patients, and ursodiol should be considered for 
      empiric treatment in RYGB patients with unexplained chronic abdominal pain.
FAU - Kumar, Nitin
AU  - Kumar N
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women's 
      Hospital, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA.
AD  - Harvard Medical School, Boston, MA, 02115, USA.
FAU - Thompson, Christopher C
AU  - Thompson CC
AUID- ORCID: 0000-0002-6105-5270
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women's 
      Hospital, 75 Francis St., Thorn 1404, Boston, MA, 02115, USA. 
      cthompson@hms.harvard.edu.
AD  - Harvard Medical School, Boston, MA, 02115, USA. cthompson@hms.harvard.edu.
LA  - eng
GR  - P30 DK034854/DK/NIDDK NIH HHS/United States
GR  - T32 DK007533/DK/NIDDK NIH HHS/United States
GR  - P30 DK034854/National Institutes of Health/
GR  - T32 DK007533/National Institutes of Health/
PT  - Journal Article
DEP - 20170810
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
RN  - 0 (Cholagogues and Choleretics)
RN  - 724L30Y2QR (Ursodeoxycholic Acid)
SB  - IM
MH  - Abdominal Pain/*drug therapy/etiology
MH  - Bile Reflux/*drug therapy/etiology
MH  - Cholagogues and Choleretics/*therapeutic use
MH  - Female
MH  - Gastric Bypass/*adverse effects/methods
MH  - Gastric Stump/*pathology/surgery
MH  - *Gastroscopy/adverse effects
MH  - Humans
MH  - *Laparoscopy/methods
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Ursodeoxycholic Acid/*therapeutic use
PMC - PMC5716841
MID - NIHMS899312
OTO - NOTNLM
OT  - Abdominal pain
OT  - Bile
OT  - Remnant gastropathy
OT  - Roux-en-Y gastric bypass
OT  - Ursodiol
EDAT- 2017/08/12 06:00
MHDA- 2018/08/23 06:00
PMCR- 2018/12/01
CRDT- 2017/08/12 06:00
PHST- 2016/12/20 00:00 [received]
PHST- 2017/05/16 00:00 [accepted]
PHST- 2017/08/12 06:00 [pubmed]
PHST- 2018/08/23 06:00 [medline]
PHST- 2017/08/12 06:00 [entrez]
PHST- 2018/12/01 00:00 [pmc-release]
AID - 10.1007/s00464-017-5621-y [pii]
AID - 10.1007/s00464-017-5621-y [doi]
PST - ppublish
SO  - Surg Endosc. 2017 Dec;31(12):5399-5402. doi: 10.1007/s00464-017-5621-y. Epub 2017 
      Aug 10.