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Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review

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Abstract

There is a lack of recommendation regarding exploration and treatment of chronic diarrhea following gastric bypass, while it is a common side effect of this surgery. The electronic databases MEDLINE and EMBASE were searched until July 2018. Of the 553 articles identified, 35 articles were included. Intestinal bacterial overgrowth and pancreatic exocrine insufficiency are the main etiologies of diarrhea following gastric bypass. The diagnostic approach must begin by eliminating infectious causes of diarrhea. Exocrine pancreatic insufficiency can be diagnosed with fecal fat quantification or fecal elastase 1 level evaluation. A positive lactulose breath test confirms suspicion of small intestine bacterial overgrowth. In conclusion, we propose sequential exploration and treatment of the possible etiologies of diarrhea depending on clinical symptoms.

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Abbreviations

AGB:

Adjustable gastric banding

BPD:

Bilio-pancreatic diversion

DANGT:

Diabetic autonomic neuropathy of the gastrointestinal tract

dRYGB:

Distal Roux-en-Y gastric bypass

DS:

Duodenal switch

IBD:

Inflammatory bowel disease

SIBO:

Small intestine bacterial overgrowth

LBT:

Lactulose breath test

OAGB:

One anastomosis gastric bypass

PCR:

Polymerase chain reaction

pRYGB:

Proximal Roux-en-Y gastric bypass

RYGB:

Roux-en-Y gastric bypass

SADIS:

Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy

SG:

Sleeve gastrectomy

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Author notes

  1. Camille Sollier and Charles Barsamian contributed equally to this work.

Authors and Affiliations

  1. AP-HP, Department of Nutrition, Centre spécialisé de l’Obesité Hôpital Européen Georges Pompidou, Paris, France

    Camille Sollier, Charles Barsamian, Claire Carette, Sébastien Czernichow & Claire Rives-Lange

  2. AP-HP, Department of Nutrition, Hôpital Ambroise Paré, Boulogne-Billancourt, France

    Marion Bretault

  3. AP-HP, Department of Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France

    Tigran Poghosyan & Jean-Marc Chevallier

  4. AP-HP, Department of Gastroenterology, Hôpital Européen Georges Pompidou, Paris, France

    Gabriel Rahmi

  5. AP-HP, Departement of Digestive Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France

    Jean-Luc Bouillot

  6. University of Paris, Paris, France

    Tigran Poghosyan, Gabriel Rahmi, Jean-Marc Chevallier, Sébastien Czernichow & Claire Rives-Lange

  7. University of Versailles Saint Quentin en Yvelines, Saint Quentin en Yvelines, France

    Jean-Luc Bouillot

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  1. Camille Sollier
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Sollier, C., Barsamian, C., Bretault, M. et al. Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review. OBES SURG 30, 1102–1111 (2020). https://doi.org/10.1007/s11695-019-04253-0

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