Psychosocial characteristics associated with symptom perception 1 year after gastric bypass surgery—a prospective study

Predicting satisfaction with outcome and follow-up care 5 years after bariatric surgery: A prospective evaluation

Objective

Patient satisfaction is viewed as essential for a successful outcome of bariatric surgery. Few studies have explored long-term satisfaction prospectively. This study aimed to examine pre- and post-surgery predictors for satisfaction with follow-up care, and change in outcome satisfaction from one to 5 years after bariatric surgery.

Methods

A sample of 210 participants was recruited from a single treatment center. Self-reported and medical record data regarding mental and somatic health, body image, follow-up attendance, and weight loss were obtained before, 1 year, and 5 years after surgery.

Results

Over 90% of the participants were satisfied with the results and treatment 1 year after surgery, while 69% had their outcome expectations fulfilled and 62% were satisfied with the follow-up 5 years after surgery. A shift from initial satisfaction to unfulfillment of expectations was predicted by baseline body dissatisfaction, greater percentage of weight regain after initial weight loss, and more discomfort from somatic symptoms 5 years after surgery. In addition to symptom discomfort, worry about surgery predicted satisfaction with follow-up care.

Conclusion

At 5 years, one-fifth of those initially satisfied reported that bariatric surgery had failed to meet their expectations. This suggests that outcome expectations related to weight loss, somatic symptoms, and body image need to be addressed both before and after bariatric surgery.

A prospective longitudinal study of chronic abdominal pain and symptoms after sleeve gastrectomy

BACKGROUND

Sleeve gastrectomy (SG) is widely applied. Few studies have evaluated patient-reported abdominal symptoms after SG.

OBJECTIVE

To evaluate the prevalence of chronic abdominal pain (CAP) and symptom characteristics after SG.

SETTING

Oslo University Hospital and Voss Hospital.

METHODS

We performed a longitudinal prospective cohort study of patients operated on with SG at two tertiary referral centers. For broad assessments of abdominal pain and symptoms, consultations were performed and questionnaires retrieved before and 2 years after SG. The definition of CAP or recurrent abdominal pain lasting for more than 3 months was sustained. Preoperative predictors of CAP were explored.

RESULTS

Of 249 patients at baseline, 207 (83.1%) had follow-up consultations. Mean preoperative body mass index was 43.9 (6.0) kg/m², and 181 patients (72.7%) were female. Total weight loss was 31.9% (10.4%). CAP was reported in 32 of 223 patients (14.3%) before and in 50 of 186 patients (26.9%) after SG (P =.002). All mean gastrointestinal symptoms rating scale questionnaire scores increased after SG, and they were higher in patients with CAP. Symptoms of depression decreased but were more prevalent in patients with CAP at follow-up. Most quality-of-life scores increased after SG. However, patients with CAP had lower scores (except for physical functioning). Preoperative bothersome Gastrointestinal Symptom Rating Scale reflux symptoms, study center, and younger age seemed to predict CAP after SG.

CONCLUSION

The prevalence of patient-reported CAP increased after SG. Patients reporting CAP had reduced quality-of-life scores.

Associations between perceived somatic symptoms and mental health after Roux-en-Y gastric bypass: a 3-year prospective cohort study

BACKGROUND

Attention to and interpretation of symptoms are influenced by psychologic and contextual factors. Preoperative anxiety, and to some extent depression, has been found to predict the perceived impact of somatic symptoms 1 year after Roux-en-Y gastric bypass. Postoperative changes in negative affect may possibly both influence and be influenced by the perception of somatic symptoms.

OBJECTIVES

This study aimed to explore whether preoperative anxiety and depressive symptoms correlated with perceived impact of somatic symptoms 3 years after Roux-en-Y gastric bypass. Second, we aimed to examine the 3-year trajectory of depressive and anxiety symptoms, and their interaction with perceived somatic symptoms postoperatively.

SETTING

University hospital.

METHODS

Presurgery, 1-, and 3-year postsurgery data were collected from 169 participants (62.4% follow-up). Anxiety and depressive symptoms were assessed at all time points. The participants reported the degree of perceived impact of various somatic symptoms 1 and 3 years after surgery. A cross-lagged, autoregressive regression analysis was employed to examine the mutual interaction of trajectories over the follow-up period.

RESULTS

Fatigue (30.8%) and dumping (23.7%) were common high-impact symptoms 3 years postoperatively. Higher baseline anxiety was associated with higher impact of fatigue, pain, and diarrhea, while depressive mood was related to higher impact of diarrhea at 3-year follow-up. Higher anxiety/depression symptoms were bidirectionally related to higher perceived total symptom impact at both 1 and 3 years postoperatively, controlling for percent total weight loss. Higher perceived impact of somatic symptom burden at 1 year after surgery predicted a significant increase in depressive symptoms the next 2 years.

CONCLUSION

Baseline anxiety was associated with higher perceived impact of several somatic symptoms 3 years after Roux-en-Y gastric bypass. Higher total symptom burden (pain, fatigue, dumping, diarrhea, and vomiting) at 1 year after surgery predicted increase in depression over the next 2 years. The results underscore the importance of managing somatic symptoms after surgery to prevent patients' distress.

A multidimensional analysis of the longitudinal effects of roux en y gastric bypass on fatigue: An association with visceral obesity

BACKGROUND AND OBJECTIVES

Severe obesity is associated with fatigue, however, the effects of weight loss after bariatric surgery on particular dimensions of fatigue are unknown. In a secondary analysis of a prospective cohort study of women undergoing roux-en-y gastric bypass (RYGB) we explored relationships among multiple dimensions of fatigue and improving adiposity, insulin resistance and inflammation.

METHODS

Before, and 1 and 6 months after RYBG, dimensions of fatigue were assessed using the validated, self-report, Multidimensional Fatigue Inventory. Total, abdominal visceral (VAT) and subcutaneous (SAT) adiposity, insulin sensitivity (Si and HOMA) and plasma concentrations of leptin, C-reactive protein (CRP) and interleukin-6 (Il-6) were measured using air displacement plethysmography, computed tomography, glucose tolerance testing and enzyme-linked immunoassay. Associations were assessed using Spearman correlations and linear regression.

RESULTS

At baseline, the majority of our female participants (N = 19, body mass index, 46.5 kg/m², age 37.2 years) were experiencing elevated levels of fatigue. By 6 months, dimensions of physical (-43%), reduced activity (-43%), reduced motivation (-38%), general (-31%; all p < .005), and mental (-18%, p < .05) fatigue improved, concomitant with decreases in markers of adiposity, inflammation and insulin resistance. The decrease in VAT was associated with improvement in mental fatigue (beta, 0.447 ± 0.203, p = .045), independent of other indices of adiposity, IL-6 concentrations, or Si.

CONCLUSIONS

In the 6 months after RYGB, fatigue improved, especially physical fatigue. Decreases in mental fatigue were strongly associated with decreases in visceral adiposity. Nevertheless, the biologic mechanisms underlying changes in these specific fatigue dimensions remain undetermined.

Gastrointestinal symptoms before and after laparoscopic Roux-en-Y gastric bypass: a longitudinal assessment

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity, but many patients have increased gastrointestinal symptoms.

OBJECTIVES

To evaluate gastrointestinal symptoms and food intolerance before and after RYGB over time in a large cohort of morbidly obese patients.

SETTING

A high-volume bariatric center of excellence.

METHODS

A prospective cohort study was performed in patients who underwent RYGB between September 2014 and July 2015, with 2-year follow-up. Consecutive patients screened for bariatric surgery answered the Gastrointestinal Symptom Rating Scale (GSRS) and a food intolerance questionnaire before RYGB and 2 years after surgery. The prevalence of gastrointestinal symptoms before and after surgery and the association between patient characteristics and postoperative gastrointestinal symptoms were assessed.

RESULTS

Follow-up was 86.2% (n = 168) for patients undergoing primary RYGB and 93.3% (n = 28) for revisional RYGB. The total mean GSRS score increased from 1.69 to 2.31 after surgery (P < .001), as did 13 of 16 of the individual scores. Preoperative GSRS score is associated with postoperative symptom severity (B = .343, P < .001). Food intolerance was present in 16.1% of patients before primary RYGB, increasing to 69.6% after surgery (P < .001). Patients who underwent revisional RYGB had a symptom severity and prevalence of food intolerance comparable with that among patients with primary RYGB, even though they had more symptoms before revisional surgery.

CONCLUSIONS

Two years after surgery, patients who underwent primary RYGB have increased gastrointestinal symptoms and food intolerance compared with the preoperative state. It is important that clinicians are aware of this and inform patients before surgery.

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

Background

Despite increased emphasis on patient‐reported outcomes, few studies have focused on abdominal pain symptoms before and after Roux‐en‐Y gastric bypass (RYGB). The aim of this study was to quantify chronic abdominal pain (CAP) in relation to RYGB.

Methods

Patients with morbid obesity planned for RYGB were invited to participate at a tertiary referral centre from February 2014 to June 2015. Participants completed a series of seven questionnaires before and 2 years after RYGB. CAP was defined as patient‐reported presence of long‐term or recurrent abdominal pain lasting for more than 3 months.

Results

A total of 236 patients were included, of whom 209 (88·6 per cent) attended follow‐up. CAP was reported by 28 patients (11·9 per cent) at baseline and 60 (28·7 per cent) at follow‐up (P < 0·001). Gastrointestinal Symptom Rating Scale (GSRS) scores (except reflux scores) and symptoms of anxiety increased from baseline to follow‐up. Most quality of life (QoL) scores (except role emotional, mental health and mental component scores) also increased. At follow‐up, patients with CAP had higher GSRS scores than those without CAP, with large effect sizes for abdominal pain and indigestion syndrome scores. Patients with CAP had more symptoms of anxiety, higher levels of catastrophizing and lower QoL scores. Baseline CAP seemed to predict CAP at follow‐up.

Conclusion

The prevalence of CAP is higher 2 years after RYGB compared with baseline values.

Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study

OBJECTIVES

Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate.

MATERIAL AND METHODS

Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years.

RESULTS

During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate.

CONCLUSIONS

We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.

Abdominal Pain After Roux-En-Y Gastric Bypass for Morbid Obesity

Background and Aims:

Roux-en-Y gastric bypass is widely used as treatment of morbid obesity. Weight loss, effects on obesity-related co-morbidities and quality of life are well documented post Roux-en-Y gastric bypass. Other outcome measures are less well studied. This review explores aspects of prevalence, diagnostic evaluations, etiology, and treatment of abdominal pain specific to Roux-en-Y gastric bypass.

Methods:

The review is based on PubMed searches and clinical experience with Roux-en-Y gastric bypass. Symptoms in the early postoperative phase (<30 days) were not included.

Results:

Based on limited evidence, up to about 30% of the patients may perceive recurrent abdominal pain post Roux-en-Y gastric bypass in the long term. A substantial subset of patients will need health-care evaluation for acute abdominal pain and hospital admission. The etiology of abdominal pain is heterogeneous and includes gallstone-related disease, intestinal obstruction, anastomotic ulcerations and strictures, intestinal dysmotility, dysfunctional eating, and food intolerance. Surgical treatment and guidance on diet and eating habits may allow symptom relief. The cause of pain remains undefined for a subset of patients. Impact of abdominal pain post Roux-en-Y gastric bypass on the perception of well-being, quality of life, and patient satisfaction with the procedure needs to be further evaluated and may be influenced by complex interactions between new symptoms post Roux-en-Y gastric bypass and relief of pre-existing symptoms.

Conclusion:

Abdominal pain should be part of follow-up consultations post Roux-en-Y gastric bypass. Future studies should focus on combined evaluations before and after surgery to enlighten potential casual relationships between abdominal pain and Roux-en-Y gastric bypass.