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Background <p>Bariatric surgery is the most effective treatment for obesity and related comorbidities, but a substantial proportion of patients develop chronic abdominal pain (CAP), defined as persistent or recurrent pain lasting more than three months. CAP significantly impairs quality of life, is reported in 30–50% of patients, and represents one of the leading causes of emergency visits and readmissions. This systematic review aims to summarize the multifactorial etiologies of CAP following bariatric surgery, highlight diagnostic challenges, and propose a multidisciplinary framework for effective management.</p> Methods <p>A comprehensive literature search (PubMed and Scopus) was conducted from inception to March 15, 2025. Eligible studies included original research, case series, case reports, observational studies, and clinical trials evaluating CAP in adult patients after primary bariatric surgery. Data on prevalence, etiology, diagnostic modalities, and therapeutic interventions were extracted and synthesized.</p> Results <p>Of the 2,111 identified articles, 51 studies met the inclusion criteria. CAP was found to have diverse etiologies, including anatomical, functional, nutritional deficiencies, biliary disorders, abdominal wall conditions, and psychological contributors. Diagnostic strategies emphasized a stepwise approach integrating history, physical examination, targeted imaging, endoscopy, laboratory studies, and psychological screening. Treatment requires etiology-specific management combining surgical, endoscopic, medical, dietary, behavioral, and psychological interventions.</p> Conclusion <p>CAP after bariatric surgery is common, multifactorial, and underrecognized, leading to significant patient morbidity and healthcare burden. A systematic, multidisciplinary diagnostic and treatment approach is essential to optimize patient outcomes, reduce readmissions, and enhance the long-term success of metabolic surgery.</p>

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Diagnosis and treatment of chronic abdominal pain after bariatric surgery: a systematic review

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Alba Zevallos,
  • Sjaak Pouwels

摘要

Background

Bariatric surgery is the most effective treatment for obesity and related comorbidities, but a substantial proportion of patients develop chronic abdominal pain (CAP), defined as persistent or recurrent pain lasting more than three months. CAP significantly impairs quality of life, is reported in 30–50% of patients, and represents one of the leading causes of emergency visits and readmissions. This systematic review aims to summarize the multifactorial etiologies of CAP following bariatric surgery, highlight diagnostic challenges, and propose a multidisciplinary framework for effective management.

Methods

A comprehensive literature search (PubMed and Scopus) was conducted from inception to March 15, 2025. Eligible studies included original research, case series, case reports, observational studies, and clinical trials evaluating CAP in adult patients after primary bariatric surgery. Data on prevalence, etiology, diagnostic modalities, and therapeutic interventions were extracted and synthesized.

Results

Of the 2,111 identified articles, 51 studies met the inclusion criteria. CAP was found to have diverse etiologies, including anatomical, functional, nutritional deficiencies, biliary disorders, abdominal wall conditions, and psychological contributors. Diagnostic strategies emphasized a stepwise approach integrating history, physical examination, targeted imaging, endoscopy, laboratory studies, and psychological screening. Treatment requires etiology-specific management combining surgical, endoscopic, medical, dietary, behavioral, and psychological interventions.

Conclusion

CAP after bariatric surgery is common, multifactorial, and underrecognized, leading to significant patient morbidity and healthcare burden. A systematic, multidisciplinary diagnostic and treatment approach is essential to optimize patient outcomes, reduce readmissions, and enhance the long-term success of metabolic surgery.