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Can Somenoe Do The Benefit Outweigh The Risks? After Gastric Bypass

GI Complaints Common 2 Years After Gastric Bypass

Patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity often experience gastrointestinal complaints as long as 2 years after the surgery, a new study suggests.

Findings from a cross-sectional comparison of 249 patients who underwent the surgery and morbidly obese controls were published online December 19 in the British Journal of Surgery by Dr Thomas CC Boerlage, of the Academic Medical Center, Amsterdam, and colleagues.

Few studies have followed patients for more than a year post–bypass surgery, even though it’s likely that symptoms beyond the first year may change after weight and diet stabilize. Indeed, the current study revealed some unexpectedly common complaints at 2 years, including indigestion, flatulence, and intolerances to certain foods.

“We knew from our clinical experience that many patients experience these complaints after surgery — that is what first brought us the idea for this study. However, we had no clear idea about the exact prevalence and which symptoms would be most prominent. To give one example, we were a little surprised that flatulence is such a big problem,” Dr Boerlage told Medscape Medical News.

Nonetheless, he advised, “Clinicians should definitely continue referring eligible patients for gastric bypass. In most cases the health benefits outweigh the side effects by far. However, it helps them to better inform their patients about what to expect after surgery.”

But in a commentary, journal editor Kjetil Søreide, MD, PhD, from the department of surgery, Stavanger University Hospital, Norway, had a different take on the findings. “This study reports an alarming number of gastrointestinal complaints after laparoscopic gastric bypass surgery,” he says, also pointing out that the study didn’t look at the sequelae of the reported problems, such as sick days and drug prescriptions.

“While obesity remains a major health challenge in many countries, this study highlights the factors that need to be considered when consenting patients for treatment and when evaluating the consequences of bariatric surgery,” Dr Søreide writes.

At 2 Years: Abdominal Pain, Nausea, Dysphagia, and Flatulence

The 249 subjects had all undergone primary LRYGB from May to October 2013 at a high-volume bariatric center. They were asked 2 years later to complete a validated general health questionnaire, the Gastrointestinal Symptom Rating Scale (GSRS), which was modified to include dysphagia, a common immediate symptom post-LRYGB. The GSRS consists of 16 gastrointestinal symptoms, each scored on a 7-point scale.

Subjects also filled out a food-intolerance questionnaire designed especially for the study, with “food intolerance” defined as any adverse event — such as nausea, dumping syndrome, or abdominal pain — that causes the patient to stop eating the food.

Results were compared with those of 295 morbidly obese people who had not had previous bariatric surgery. Continue Reading

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