Abstract
Background/AimA number of patients continue to suffer from chronic abdominal pain of unknown origin, which may also lead to a prolonged use of opioid analgesics. Symptoms of abdominal pain, nausea and vomiting in this patient group resemble the characteristics of the Roux stasis Syndrome. The aim was to elucidate relationships between chronic abdominal pain, Roux limb motor activity and opioid analgesics.MethodsRoux limb high-resolution manometry and ratings of abdominal pain and quality of life were analysed in 15 gastric bypass patients reporting abdominal pain of unknown origin. Effect of acute opiate administration (morphine i.v.) on fasting Roux limb motor activity was assessed in asymptomatic and morphine-naïve gastric bypass patients (n = 9) and compared with an untreated control group (n = 11).ResultsIn the symptomatic patient group, we found disturbed Roux limb motor patterns in 10 out of 15 examinations, but no signs of Roux stasis syndrome. A high prevalence of prescribed opioid analgesics as well as a high number of reoperations in this group. The worst quality of life and the highest number of pain-killing medications were observed among the patients with distal pacemaker activity in Roux limb. In the morphine-naïve and asymptomatic patients, morphine increased the muscular tone in the Roux limb during phase III-like motor activity.Summary and ConclusionsA majority of the RYGBP patients with chronic abdominal pain had a disturbed Roux limb fasting motility, and there was a high prevalence of prescribed opioid analgesics. In opiate-naïve RYGBP patients, acute morphine intravenously increased the muscular tone of the Roux limb.
Highlights
Obesity is an important worldwide public health problem
The aim of the present study was to analyse retrospectively Roux limb manometry examinations of Roux-en-Y Gastric Bypass (RYGBP) patients who complain of chronic abdominal pain, and to investigate morphine influence on Roux limb manometry in asymptomatic RYGBP patients
Sixteen patients with severe gastrointestinal symptoms after RYGBP were referred to manometry of the gastric pouch and Roux limb
Summary
Obesity is an important worldwide public health problem. The WHO reports that, in 2014, 39% of adults aged 18 years and over was overweight and 13% was obese [1]. Greenstein and O’Rourke list a number of causes for abdominal pain in the gastric bypass-operated patient spanning from more general functional disorders and cholelithiasis to procedure dependent internal herniations and gastro-gastric fistulas [8]. These authors state that in the absence of a clear diagnosis, the threshold for surgical exploration should be low. In a 5-year follow-up study by Høgestøl et al, chronic abdominal pain was reported in 34% of patients operated with RYGBP [9]. Underlying mechanisms of chronic abdominal pain after gastric bypass are still enigmatic and of paramount importance to elucidate
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