A case of chronic exocrine pancreatic insufficiency in a gastric bypass patient: Chronic pancreatic insufficiency in gastric bypass patient

Laxman Wagle; Dhiraj Raj Regmi; Sabita Regmi

doi:10.28982/josam.7897

Authors

Laxman Wagle Department of Internal Medicine, Ascension Saint Agnes Hospital, USA https://orcid.org/0009-0000-5651-1246
Dhiraj Raj Regmi Department of Internal Medicine, MedStar Franklin Square Medical Center, USA https://orcid.org/0009-0001-2323-0760
Sabita Regmi Maharajgunj Medical Campus, Institute of Medicine, Nepal https://orcid.org/0009-0007-0515-0525

DOI:

https://doi.org/10.28982/josam.7897

Keywords:

exocrine pancreatic insufficiency, roux-en-y gastric bypass, fecal elastase, pancreatic enzyme replacement therapy, case report

Abstract

Exocrine pancreatic insufficiency (EPI) is a significant complication of bariatric surgery, but its frequency and outcomes are not well-studied. If EPI is not diagnosed, it can result in nutritional deficiencies, dehydration, and acute kidney damage. Our patient, a 47-year-old woman, underwent Roux-en-Y gastric bypass (RYGB) surgery due to morbid obesity four years ago and lost contact with outpatient follow-ups. She came to us presenting chronic diarrhea and fatigue and was diagnosed with chronic pancreatic exocrine deficiency based on a low fecal elastase level. After starting her on pancreatic enzymes, her symptoms resolved. It is crucial to maintain a high degree of suspicion in order to diagnose EPI in patients who have undergone RYGB. The fecal elastase test, which is both reliable and inexpensive, is an effective diagnostic tool for EPI; prompt treatment can alleviate symptoms within days.

Downloads

Download data is not yet available.

References

Moore HN, Chirco AR, Plescia T, Ahmed S, Jachniewicz B, Rajasekar G, et al. Exocrine pancreatic insufficiency after bariatric surgery: a bariatric surgery center of excellence experience. Surg Endosc. 2023 Feb;37(2):1466-75. DOI: https://doi.org/10.1007/s00464-022-09388-3

Löser CHR, Möllgaard A, Fölsch UR. Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut. 1996;39(4):580-6. DOI: https://doi.org/10.1136/gut.39.4.580

Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129. DOI: https://doi.org/10.2147/CEG.S168266

Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et.al. American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan;33(1):3-14. DOI: https://doi.org/10.1007/s11695-022-06332-1

Abdeen G, le Roux C. Mechanism Underlying the Weight Loss and Complications of Roux-en-Y Gastric Bypass. Review. Obes Surg. 2016;26:410–21. DOI: https://doi.org/10.1007/s11695-015-1945-7

Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg. 1986;52(11):594.

Brolin RE, LaMarca LB, Kenler HA, Cody RP. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–205. DOI: https://doi.org/10.1016/S1091-255X(01)00022-1