Weight Loss Surgery Linked to Long-Term Digestive Issues

Laparoscopic bypass reduces stomach to the size of an egg

A new study conducted in the Netherlands has found that laparoscopic Roux-en-Y gastric bypass (LRYGB), a common treatment for patients with morbid obesity, may cause lasting gastrointestinal (GI) problems and food intolerance. LRYGB reduces the stomach to a small pouch about the size of an egg.

In the cross-sectional investigation, which was published in the British Journal of Surgery, patients who underwent primary LRYGB from May to October 2012 were contacted two years after surgery and were asked to complete a general health questionnaire; the Gastrointestinal Symptom Rating Scale (GSRS); and a food intolerance questionnaire. The results were compared with those from a control group of morbidly obese patients.

Two hundred and forty-nine patients were included in the analysis. The median GSRS score was significantly higher in the patients who had undergone LRYGB than in those who had not (2.19 versus 1.75, respectively; P < 0.001). The difference in symptoms of indigestion was also significant between the two groups (P < 0.001). Food intolerance for specific products was reported by 71% of the postoperative patients compared with 17% of the control group. There was a positive correlation between food intolerance and the GSRS score.

The most common GI problems included indigestion, stomach gurgling, flatulence, belching, and hard or loose stools. The postoperative group had an average of 2.2 GI symptoms compared with 1.8 symptoms in the control group.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” lead author Dr. Thomas Boerlage said in an email to the Reuters news service. “However, most of these studies concerned the first year after surgery.”

The authors noted that, in addition to its small size, the study lacked data on patients’ symptoms before surgery, making it impossible to determine which GI or digestive issues might have been due to the operations.

Guidelines recommending weight-loss surgery as a treatment for diabetes in obese patients were recently endorsed by 45 international organizations, including the American Diabetes Association. In most cases, the guidelines say, surgery can lead to reductions in blood glucose levels below the type-2 diabetes diagnosis threshold or to a substantial improvement in blood glucose levels. In many cases, this would allow patients to stop or significantly reduce their diabetes medications.

Sources: Reuters; December 28, 2016; and BJS; December 19, 2016.