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Symptomatic Marginal Ulcer Disease After Roux-en-Y Gastric Bypass: Incidence, Risk Factors and Management

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Abstract

Background

One of the long-term complications of laparoscopic Roux-and-Y gastric bypass (LRYGB) is the development of marginal ulcers (MU). The aim of the present study is to assess the incidence, risk factors, symptomatology and management of patients with symptomatic MU after LRYGB surgery.

Methods

A consecutive series of patients who underwent a LRYGB from 2006 until 2011 were evaluated in this study. Signs of abdominal pain, pyrosis, nausea or other symptoms of ulcer disease were analysed. Acute symptoms of (perforated) MU such as severe abdominal pain, vomiting, melena and haematemesis were also collected. Patient baseline characteristics, medication and intoxications were recorded. Statistical analysis was performed to identify risk factors associated with MU.

Results

A total of 350 patients underwent a LRYGB. Minimal follow-up was 24 months. Twenty-three patients (6.6 %) developed a symptomatic MU of which four (1.1 %) presented with perforation. Smoking, the use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with the development of MU. Five out of 23 patients (22 %) underwent surgery. All other patients could be treated conservatively.

Conclusions

Marginal ulcers occurred in 6.6 % of the patients after a LRYGB. Smoking, the use of corticosteroids and the use of NSAIDs were associated with an increased risk of MU. Most patients were managed conservatively.

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Abbreviations

DM:

Diabetes mellitus

EGD:

Esophago-gastro-duodenoscopy

GJS:

Gastrojejunostomy

H. pylori :

Helicobacter pylori

LABG:

Laparoscopic adjustable gastric band

LSG:

Laparoscopic sleeve gastrectomy

MU:

Marginal ulcer

NSAIDs:

Non-steroidal inflammatory drugs

PPI:

Proton pump inhibitor

(L)RYGB:

Roux-en-Y gastric bypass (laparoscopic)

PUD:

Peptic ulcer disease

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Conflict of Interest

U.K. Coblijn, S.M.M. de Castro, S.D. Kuiken, and B.A. van Wagensveld report no conflict of interest. S.M. Lagarde is supported by a Koningin Wilhelmina Fonds (KWF, Dutch Cancer Society) Fellowship, UVA 2013-5853). This does not create a conflict of interest.

Statement of Informed Consent

The study was approved by the Medical Ethical Board and agreed that informed consent was not indicated (see also below).

Statement of Human and Animal Rights

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Because it is a retrospective study: “For this type of study formal consent is not required.”

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Authors and Affiliations

  1. Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Usha K. Coblijn, Sjoerd M. Lagarde, Steve M. M. de Castro & Bart A. van Wagensveld

  2. Department of Gastroenterology, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Sjoerd D. Kuiken

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  1. Usha K. Coblijn
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Correspondence to Usha K. Coblijn.

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Coblijn, U.K., Lagarde, S.M., de Castro, S.M.M. et al. Symptomatic Marginal Ulcer Disease After Roux-en-Y Gastric Bypass: Incidence, Risk Factors and Management. OBES SURG 25, 805–811 (2015). https://doi.org/10.1007/s11695-014-1482-9

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  • DOI: https://doi.org/10.1007/s11695-014-1482-9

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