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Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management
Marita Salame1, Noura Jawhar2, Amanda Belluzzi1
1Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Abstract:
Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.
Insights
Marginal ulcers (MU) can occur after Roux-en-Y gastric bypass (RYGB), affecting 4.6% of patients. Prompt diagnosis and treatment are key to managing this complication and preventing serious issues.
Area of Science:
- Gastroenterology
- Bariatric Surgery
Background:
- Marginal ulcer (MU) is a recognized complication after Roux-en-Y gastric bypass (RYGB).
- It has a reported prevalence of approximately 4.6% and requires timely management to prevent severe outcomes.
Purpose of the Study:
- To provide a comprehensive overview of the etiology, diagnosis, and management strategies for marginal ulcers following RYGB.
Main Methods:
- This review synthesizes current literature on MU after RYGB.
- It covers risk factors, clinical presentation, diagnostic modalities, and therapeutic approaches.
Main Results:
- MU pathophysiology involves factors like smoking, H. pylori, NSAIDs, and pouch size.
- Symptoms range from abdominal pain to bleeding, perforation, or strictures.
- Diagnosis is typically via endoscopy, with management involving risk factor modification, PPIs, and sometimes surgery.
Conclusions:
- Early detection and intervention are critical for managing MU post-RYGB.
- A multi-faceted approach combining medical and surgical strategies is often necessary for complex or recurrent cases.
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