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.