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Roux Limb Motility in Gastric Bypass Patients with Chronic Abdominal Pain—Is There an Association to Prescribed Opioids?

Journal article
Authors Per Björklund
Almantas Maleckas
Hans Lönroth
Niclas Björnfot
Sven Egron Thörn
Lars Fändriks
Published in Obesity Surgery
ISSN 0960-8923
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Clinical Sciences, Department of Gastrosurgical Research and Education
Language en
Links dx.doi.org/10.1007/s11695-019-04056...
Keywords Bariatric, Intestinal motility, Manometry, Opiates
Subject categories Gastroenterology and Hepatology

Abstract

Background/Aim: A 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. Methods: Roux 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). Results: In 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 Conclusions: A 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. © 2019, The Author(s).

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