The role of citrulline, intestinal fatty acid–binding protein, and D-dimer as potential biomarkers in the diagnosis of internal herniation after Roux-en-Y gastric bypass
Zaigham, Hassan LU
; Olsson Regnér, Åsa
; Ekelund, Mikael
LU
and Regnér, Sara
LU
(2021)
In Surgery for Obesity and Related Diseases
17(10).
p.1704-1712
- Abstract
Background: Diagnosing internal herniation (IH) in Roux-en-Y gastric bypass (RYGB) patients with acute abdominal pain poses a diagnostic challenge. Diagnostic laparoscopy is often required for a definitive diagnosis. We hypothesized that intestinal ischemia biomarkers would aid in the diagnosing of IH. Objectives: To explore intestinal ischemia biomarkers in diagnosing IH. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 46 RYGB patients admitted for acute abdominal pain between June 2015 and December 2017. Blood samples for analysis of citrulline, intestinal fatty acid–binding protein (I-FABP), and D-dimer were drawn <72 hours from admission and compared between patients with IH (n = 8), small bowel... (More)
Background: Diagnosing internal herniation (IH) in Roux-en-Y gastric bypass (RYGB) patients with acute abdominal pain poses a diagnostic challenge. Diagnostic laparoscopy is often required for a definitive diagnosis. We hypothesized that intestinal ischemia biomarkers would aid in the diagnosing of IH. Objectives: To explore intestinal ischemia biomarkers in diagnosing IH. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 46 RYGB patients admitted for acute abdominal pain between June 2015 and December 2017. Blood samples for analysis of citrulline, intestinal fatty acid–binding protein (I-FABP), and D-dimer were drawn <72 hours from admission and compared between patients with IH (n = 8), small bowel obstruction (SBO) (n = 5), other specified diagnoses (n = 12), or unspecified abdominal pain (n = 21). Levels of white blood cell count (WBC), C-reactive protein (CRP), and lactate at admission were compared. A prospective pain questionnaire for time of pain onset and level of pain at onset and at admission was analyzed. Results: None of the investigated biomarkers differed significantly between diagnosis categories. Most patients with IH had normal CRP, WBC, and D-dimer levels while their lactate levels were significantly lower (P = .029) compared with the rest of the cohort. Neither pain level nor pain duration differed between the groups. Conclusion: This study shows that citrulline, I-FABP, and D-dimer cannot be used to diagnose IH and indicates that CRP, D-dimer, and lactate are rarely elevated by an IH. Furthermore, pain intensity and duration cannot differentiate patients with IH. A diagnostic laparoscopy remains the gold standard to diagnose and rule out an IH.
(Less)
- author
- Zaigham, Hassan
LU
; Olsson Regnér, Åsa
; Ekelund, Mikael
LU
and Regnér, Sara
LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Abdominal pain, Biomarkers, Citrulline, D-dimer, Gastric bypass, Internal herniation, Intestinal fatty acid–binding protein, Lactate
- in
- Surgery for Obesity and Related Diseases
- volume
- 17
- issue
- 10
- pages
- 1704 - 1712
- publisher
- Elsevier
- external identifiers
-
- pmid:34167910
- scopus:85108574742
- ISSN
- 1550-7289
- DOI
- 10.1016/j.soard.2021.05.028
- language
- English
- LU publication?
- yes
- id
- be0523bd-5b24-494a-ae65-47a71a614d03
- date added to LUP
- 2021-08-16 09:39:13
- date last changed
- 2025-10-14 09:34:00
@article{be0523bd-5b24-494a-ae65-47a71a614d03,
abstract = {{<p>Background: Diagnosing internal herniation (IH) in Roux-en-Y gastric bypass (RYGB) patients with acute abdominal pain poses a diagnostic challenge. Diagnostic laparoscopy is often required for a definitive diagnosis. We hypothesized that intestinal ischemia biomarkers would aid in the diagnosing of IH. Objectives: To explore intestinal ischemia biomarkers in diagnosing IH. Setting: University Hospital, Sweden. Methods: Prospective inclusion of 46 RYGB patients admitted for acute abdominal pain between June 2015 and December 2017. Blood samples for analysis of citrulline, intestinal fatty acid–binding protein (I-FABP), and D-dimer were drawn <72 hours from admission and compared between patients with IH (n = 8), small bowel obstruction (SBO) (n = 5), other specified diagnoses (n = 12), or unspecified abdominal pain (n = 21). Levels of white blood cell count (WBC), C-reactive protein (CRP), and lactate at admission were compared. A prospective pain questionnaire for time of pain onset and level of pain at onset and at admission was analyzed. Results: None of the investigated biomarkers differed significantly between diagnosis categories. Most patients with IH had normal CRP, WBC, and D-dimer levels while their lactate levels were significantly lower (P = .029) compared with the rest of the cohort. Neither pain level nor pain duration differed between the groups. Conclusion: This study shows that citrulline, I-FABP, and D-dimer cannot be used to diagnose IH and indicates that CRP, D-dimer, and lactate are rarely elevated by an IH. Furthermore, pain intensity and duration cannot differentiate patients with IH. A diagnostic laparoscopy remains the gold standard to diagnose and rule out an IH.</p>}},
author = {{Zaigham, Hassan and Olsson Regnér, Åsa and Ekelund, Mikael and Regnér, Sara}},
issn = {{1550-7289}},
keywords = {{Abdominal pain; Biomarkers; Citrulline; D-dimer; Gastric bypass; Internal herniation; Intestinal fatty acid–binding protein; Lactate}},
language = {{eng}},
number = {{10}},
pages = {{1704--1712}},
publisher = {{Elsevier}},
series = {{Surgery for Obesity and Related Diseases}},
title = {{The role of citrulline, intestinal fatty acid–binding protein, and D-dimer as potential biomarkers in the diagnosis of internal herniation after Roux-en-Y gastric bypass}},
url = {{http://dx.doi.org/10.1016/j.soard.2021.05.028}},
doi = {{10.1016/j.soard.2021.05.028}},
volume = {{17}},
year = {{2021}},
}