Van Osdol Andrew D, Kallies Kara J, Fredrickson Kyla A, Kothari Shanu N
Minimally Invasive Bariatric Surgery and Advanced Laparoscopy Fellowship, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
World J Surg. 2017 Sep;41(9):2324-2328. doi: 10.1007/s00268-017-4048-x.
Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported.
The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified.
Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2-27). All 16 patients received intravenous iron and pica symptoms resolved.
Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.
由于吸收改变，Roux-en-y胃旁路术后患者可能会出现缺铁情况。异食癖，即强迫性渴望并摄入非营养性物质，是缺铁的一种罕见且了解甚少的表现形式。据我们所知，RYGB术后异食癖的发生率从未有过报道。
回顾了2001年至2011年接受腹腔镜RYGB手术患者的病历。确定有异食癖或其他异常渴望的患者。
在研究期间接受RYGB手术的959例患者中，有16例（1.7%）被确定为有异食癖。最常见的表现症状是嗜冰癖。所有有异食癖的患者均为女性，且有多种缺铁风险因素，其中16例中有13例处于绝经前，16例中有7例未遵医嘱口服铁剂补充剂。异食癖症状在RYGB术后平均3.9±1.9年出现。16例患者均被诊断为缺铁，铁蛋白水平中位数为5.0 ng/mL（范围2 - 27）。所有16例患者均接受了静脉补铁，异食癖症状得以缓解。
异食癖是一种与缺铁相关的罕见现象，即使口服铁剂补充剂也可能发生。根据我们的经验，静脉补铁可缓解症状。应向考虑接受减重手术的患者告知异食癖相关情况。对有异常渴望的患者应评估是否缺铁。
