Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem?

Abstract

Background: Roux-en-Y gastric bypass (RYGB) can cause multiple food intolerances and gastrointestinal complaints are frequently reported after dairy consumption. We aimed to determine the prevalence of lactose malabsorption and intolerance, and complaints associated with dairy consumption in daily life, before and after RYGB. Method: The lactose breath test (LBT) and lactose tolerance test (LTT) was performed in 84 patients awaiting RYGB surgery and 84 patients after surgery. Gastrointestinal symptoms at baseline and after testing were recorded. Lactose malabsorption was defined as a positive LBT and/or LTT. Lactose intolerance as a positive test combined with an increase of gastrointestinal complains. Dairy consumption in daily life and successive gastrointestinal complaints were registered via a questionnaire. Results of preoperative and postoperative patients were compared. Results: Lactose malabsorption was present in 15 (17.9%) of the preoperative patients and in 25 (29.8%) of the postoperative patients (OR 2.46; 95%CI: 1.08-5.59; p ¼ .03). Of the preoperative patients 6 (7.1%) patients met the criteria for lactose intolerance, compared to 8 (9.5%) patients in the postoperative group (OR 1.48; 95%CI 0.48-4.57; p ¼ .50). Twelve (14.3%) preoperative patients indicated to have gastrointestinal complaints after dairy consumption in daily life versus 45 (53.6%) postoperative patients (p < .01). Conclusion: This study shows no increase in patients with proven lactose intolerance after RYGB compared to preoperative patients. Gastrointestinal complaints after dairy consumption in daily life were far more frequently reported by RYGB patients. It is unlikely that all reported gastrointestinal complaints are actually caused by lactose. Other ingredients in dairy, like fat, are possibly contributory.

Long-term changes in dietary intake and its association with eating-related problems after gastric bypass in adolescents

“…Decreased milk consumption after RYGB has also been reported in adults up to two years after surgery(22). The reason to decreased consumption was not investigated in the present study but others have found more frequently reported gastrointestinal complaints after dairy consumption in RYGB patients(23). The low consumption of milk is a concern in relation to previous findings reported from the present…”

Psychometric Analysis of the Rapid Eating Assessment for Participants-Short Form to Evaluate Dietary Quality in a Pre-Surgical Bariatric Population

“…For instance, although eating more than 8 ounces a day of animal sources of protein (including lean ones) contributes to a lower REAP-S score, it is often recommended that pre-and post-bariatric patients consume foods or supplements rich in proteins over those rich in carbohydrates or fats to avoid protein deficiency and promote satiety [29][30][31]. Additional considerations should be made to other items that compose the REAP-S score, which can be of difficult adherence by patients both immediately following surgery as well as for long-term follow-up due to their reduced stomach capacity and common complaints about gastrointestinal issues [32]; however, that was not the immediate focus of this particular study.…”

Breath Tests Used in the Context of Bariatric Surgery

“…Before surgery, 17.9% of patients showed positive results for lactose malabsorption. After surgery, 29.8% of patients showed positive results for lactose malabsorption [ 41 ]. Sendiny et al (2020) studied lactose malabsorption in patients that had not undergone bariatric treatments.…”

“…They compared 84 patients that were preparing for the RYGB procedure to 84 patients that had undergone the procedure. Lactose malabsorption was observed in 17.9% (N = 15) of patients before bariatric surgery and in 29.8% (N = 25) of patients after surgery [ 41 ].…”