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 Researchers examined data on 249 extremely obese patients who had
what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces
the stomach to a small pouch about the size of an egg.
Two years after surgery, these patients had lost about 31 percent of
their total body weight on average. But compared to the control
group of 295 obese people who didn’t have operations, the gastric
bypass patients were far more likely to experience indigestion and
an inability to tolerate multiple foods.
“It was already known from previous studies that the Roux-en-Y
gastric bypass might aggravate gastrointestinal symptoms after
surgery,” said lead study author Dr. Thomas Boerlage of MC
Slotervaart in Amsterdam.
“However, most of these studies concern the first year after
surgery,” Boerlage added by email.
At the start of the study in 2012, patients were 46 years old on
average. About 45 percent of them had high blood pressure and 29
percent had diabetes.
Researchers surveyed all of the patients and the comparison group of
obese people who didn’t have surgery, to ask about 16 different
gastrointestinal symptoms. They found the postoperative group had
2.2 symptoms on average, compared to 1.8 with the control group.
The most common gastrointestinal problems included indigestion,
stomach gurgling, flatulence, belching, and hard or loose stools,
researchers report in the British Journal of Surgery.
Hunger pains were more pronounced in the non-surgery group.
About 71 percent of the postoperative patients experienced food
intolerance, compared with 17 percent in the control group.
Among the subset of surgery patients who reported food intolerance,
half of them had an aversion to at least four different types of
food and 14 percent said the intolerance was very bothersome.
The foods post-surgery patients most often reported as being
problematic were fried foods, carbonated drinks, cakes, pies and
pastries. Some also reported issues with ice cream and spicy food.
By comparison, people in the control group most often reported
intolerance to milk and fried foods.
There wasn’t any relationship between the amount of weight loss
during the study and the number of food intolerances.
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Beyond its small size, one limitation of the study is that
researchers lacked data on symptoms prior to surgery, making it
impossible to determine what gastrointestinal or digestive issues
might actually be due to the operations, the authors note.
Even though Roux-en-Y was the most common type of gastric bypass
when this study was done, another procedure known as sleeve
gastrectomy, which reduces the stomach to the size of a banana, now
accounts for more operations, said Dr. Andrei Keidar of Rabin
Medical Center and Tel Aviv University in Israel.
“It is more likely to have less gastrointestinal side effects,”
Keidar, who wasn’t involved in the study, said by email.
Gastric bypass patients are also advised to avoid certain foods that
may be hard to digest after surgery, and many of the patients
experiencing food intolerance failed to follow this advice, noted
Dr. Anita Courcoulas, a researcher at the University of Pittsburgh
Medical Center who wasn’t involved in the study.
“The top food intolerances included carbonated beverages, fried
foods, and red meats, which all potential bypass patients are told
to avoid or eliminate,” Courcoulas said by email. “So while the
study provides useful information, it is not surprising.”
Guidelines recommending weight loss surgery as a treatment for
diabetes in obese patients were recently endorsed by 45
international organizations, diabetes specialists and researchers,
including the International Diabetes Federation, the American
Diabetes Association, the Chinese Diabetes Society and Diabetes
India.
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 lead to patients being able to give up or
significantly reduce their diabetes medications.
SOURCE: http://bit.ly/2hwD7po British Journal of Surgery, online
December 19, 2016.
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