Gastrointestinal symptom improvement after Roux-en-Y gastric bypass: long-term analysis

Abstract

Background: Obese patients have a multitude of gastrointestinal symptoms that differ from their nonobese counterparts. The published data remain scant on changes in gastrointestinal symptoms among this cohort before and after Roux-en-Y gastric bypass (RYGB). The aim of this study was to quantify these symptoms and understand the changes that occur after bariatric surgery.

Methods: A total of 1724 gastrointestinal symptom surveys were prospectively administered to 763 consecutive patients who underwent laparoscopic RYGB. The patients rated each symptom on a 0-100-mm Liekert scale: 0, absence of symptoms; 33, occasional occurrence; 67, frequent occurrence; 100, continuous. The surveys were administered preoperatively and yearly thereafter. The data are presented as the mean + or - standard error of the mean.

Results: Of the 763 patients, 137 were black, 610 were white, and 16 were Hispanic; 83% were women and 17% were men. Their age was 40.8 + or - 0.34 years. The body mass index was 48.4 + or - 0.27 kg/m(2). The American Society of Anesthesiologists class was 2 for 31%, 3 for 68%, and 4 for 1%. Of the 763 patients, 63% underwent short-limb RYGB and 37% underwent long-limb RYGB. The preoperative symptom rating was as follows: abdominal pain, 24.3 + or - 0.7; heartburn, 41.0 + or - 0.8; acid regurgitation, 30.9 + or - 0.9; gnawing epigastric sensation, 26.5 + or - 0.9; nausea/vomiting, 18.8 + or - 0.7; borborygmus, 26.2 + or - 0.8; abdominal distension, 30.3 + or - 0.9; eructation, 28.0 + or - 0.8; increased flatus, 38.9 + or - 0.8; decreased passage of stool, 14.8 + or - 0.8; increased passage of stool, 16.4 + or - 0.7; loose stools, 22.1 + or - 0.8; hard stools, 20.5 + or - 0.9; urgent need for defecation, 23.2 + or - 0.8; incomplete evacuation, 22.2 + or - 0.8; difficulty falling asleep, 42.0 + or - 1.1; insomnia, 38.4 + or - 1; feeling rested, 60.1 + or - 1; and difficulty swallowing, 13.5 + or - 0.67. At 1, 2, 3, 4, and 5 years after RYGB, 99.5% 84.2%, 68.4%, 57.9% and 47.4% of these symptoms had improved significantly (P < .05).

Conclusion: Laparoscopic RYGB significantly improves the gastrointestinal symptoms experienced by morbidly obese patients without adversely affecting any of the measured parameters. This improvement in symptoms proved durable in the long term.