Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Chahal-Kummen, Monica; Blom-Høgestøl, Ingvild Kristine; Eribe, Inger; Klungsøyr, Ole; Kristinsson, Jon; Mala, Tom

doi:10.1002/bjs5.50148

Cited by 30 publications

(35 citation statements)

References 34 publications

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“…The observed improvements in the physical functioning aspects of HRQoL after RYGB have previously been described [9, 12]. However, we are the first to describe that the improved physical functioning is irrespective of the presence of IBS-like symptoms after RYGB.…”

Section: Discussionsupporting

confidence: 66%

“…Both constipation and diarrhea symptoms increased after RYGB, with a comparable mean change in participants with and without IBS at the preoperative visit. Previous studies have shown diverging dynamics of these symptoms after RYGB [12, 28, 29]. However, although statistically significant, the absolute changes in mean diarrhea and constipation symptom score are unlikely to be of high clinically importance (< 15% increase in symptom score), with exception of the subgroup of participants with new onset of IBS-like symptoms after RYGB who experienced a mean 33% increase for both diarrhea and constipation symptom scores.…”

Section: Discussionmentioning

confidence: 78%

“…RYGB enables a large and sustained weight loss, improvement of obesity-related co-morbidities and health related quality of life (HRQoL), with low risk of surgical complications [7–9]. However, recent reports indicate that abdominal pain is common 2–5 years after RYGB [10–12]. Internal herniation and gallstone related disease are common causes of acute pain, whereas the etiology of chronic abdominal pain after RYGB is less well understood [13–15].…”

Section: Introductionmentioning

confidence: 99%

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Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

et al. 2019

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BackgroundIrritable bowel syndrome (IBS) is prevalent in patients with morbid obesity. After Roux-en-Y gastric bypass (RYGB) chronic abdominal pain is common, however the etiology is largely unknown. We aimed to study the change in the prevalence of IBS-like symptoms 2 years after RYGB and possible preoperative predictors of such symptoms. Secondly, to evaluate changes in symptoms of constipation and diarrhea, and Health related quality of life (HRQoL).MethodsPatients with morbid obesity were included at two obesity centers in South-Eastern Norway. IBS was diagnosed according to the Rome III criteria. Predictors were evaluated in a multivariable logistic regression analysis.ResultsOf 307 participants operated with RYGB, 233 (76%) completed the study questionnaires. Preoperatively 27/233 participants (12%) had IBS, 2 years after RYGB 61/233 (26%) had IBS-like symptoms (p < 0.001). Eleven participants with IBS preoperatively (41%) did not report such symptoms after RYGB. New onset IBS-like symptoms was identified in 45/206 (22%) after RYGB. Fibromyalgia, low LDL levels, high vitamin B1 levels and IBS before RYGB were independent preoperative predictors of IBS-like symptoms at the follow-up visit. Symptom scores for constipation preoperatively and 2 year after RYGB were 1.5 (0.9) and 1.8 (1.2), and for diarrhea 1.4 (0.9) and 1.8 (1.1), respectively (p < 0.001). We observed a significant improvement in the physical component score for all participants. However, participants with new onset IBS-like symptoms had a significant worsening of the mental component score.ConclusionsThe prevalence of IBS-like symptoms doubled 2 years after RYGB, and these symptoms were associated with reduced HRQoL. Preoperative IBS and fibromyalgia were strong predictors of postoperative IBS-like symptoms.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

et al. 2019

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“…We do not have preoperative data, and the preoperative symptom burden may have been high. We have recently published before and after RYGB data reporting similar GSRS scores in 28.1% patients two years after surgery [19]. In another study, we found that 32.8% of the patients reported bothersome abdominal pain symptoms 5 years after RYGB [20].…”

Section: Discussionmentioning

confidence: 68%

“…Long-term evaluations on gastrointestinal symptoms after RYGB are limited. We have previously observed high rates of such symptoms 2 and 5 years after RYGB [ 19 , 20 ]. Long-term evaluations and knowledge of such symptoms may improve the quality of health care for these patients.…”

mentioning

confidence: 99%

Health benefits and risks during 10 years after Roux-en-Y gastric bypass

et al. 2020

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Background Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. Methods We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. Results A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. Conclusion We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL. Keywords Long-term outcomes • Gastric bypass • Weight loss • Cardiovascular risk factors • Gastrointestinal symptoms Roux-en-Y gastric bypass (RYGB) surgery is commonly applied for the treatment of morbid obesity. Short-term and medium-term outcomes are well documented and include health benefits such as significant weight loss, improvement in obesity-related comorbidities and improved quality of life (QoL) [1-5]. A limited number of studies reports on outcomes 10 years and beyond after RYGB [6-18]. Available studies indicate sustained weight loss and high remission rates of diabetes, hypertension, and dyslipidemia after RYGB. The follow-up rates, however, are often low. Long-term evaluations on gastrointestinal symptoms after RYGB are limited. We have previously observed high rates of such symptoms 2 and 5 years after RYGB [19, 20]. Long-term evaluations and knowledge of such symptoms may improve the quality of health care for these patients. Pending results from national and multinational databases will enlighten long-term outcomes after bariatric surgery. However, prospective cohort studies may supplement larger register-based studies, with in-depth individual evaluations. A single-center cohort study aiming to report weight development and remission of metabolic comorbidities, gastrointestinal symptom...

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Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index

Salte,

Olbers,

Risstad

et al. 2024

JAMA Netw Open

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ImportanceResults from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce.ObjectiveTo compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity—that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60.Design, Setting, and ParticipantsThis open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023.InterventionsLaparoscopic RYGB or laparoscopic DS.Main Outcomes and MeasuresThe main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life.ResultsForty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P &lt; .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery.Conclusions and RelevanceIn this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60.Trial RegistrationClinicalTrials.gov Identifier: NCT00327912

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Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass

Cited by 30 publications

References 34 publications

Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study

Health benefits and risks during 10 years after Roux-en-Y gastric bypass

Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index

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