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Gastrointestinal symptoms after bariatric surgery—more focus needed
Author’s Accepted Manuscript Gastrointestinal symptoms after bariatric surgery More focus needed Tom Mala, Jon Kristinsson
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1550-7289(17)30140-5 http://dx.doi.org/10.1016/j.soard.2017.03.009 SOARD2964
To appear in: Surgery for Obesity and Related Diseases Cite this article as: Tom Mala and Jon Kristinsson, Gastrointestinal symptoms after bariatric surgery - More focus needed, Surgery for Obesity and Related Diseases, http://dx.doi.org/10.1016/j.soard.2017.03.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to Editor SOARD
Gastrointestinal symptoms after bariatric surgery - more focus needed
Tom Mala, MD, PhD Jon Kristinsson, MD, PhD Dep. of Morbid Obesity and Bariatric Surgery and Dep. of Gastrointestinal Surgery Oslo University Hospital Oslo, Norway
Corresponding Author; Tom Mala Dep. of Gastrointestinal Surgery, Ullevål Oslo University Hospital Kirkeveien 166, 0450 Oslo Norway e-mail; [email protected] Telephone; +47 92458235
Surg Obes Relat Dis; Letter to Editor
Beneficial short and long-term effects of bariatric surgery are well documented. Less is known about long-term side effects and adverse events. The 1991 recommendations for performing bariatric surgery are founded on limited evidence of long-term effects of contemporary procedures. Acceptance of side effects related to bariatric surgery may vary for health care providers and the individual patient according to factors such as presence of serious obesity related comorbidities or not, or degree of obesity. The total burden of side effects may vary according to type of procedure. Bariatric surgery for patients with body mass index <35 kg/m2 may be beneficial for many, but the benefits may be less obvious for subgroups of patients. A long-term aspect of bariatric surgery less focused on is abdominal pain and discomfort. It should be no surprise that such symptoms occur. Common causes include gall stone disease, internal herniation, gastrointestinal acid or bile reflux, anastomotic ulcers, and symptoms such as dumping and food intolerance. The etiology of symptoms may not always be defined despite extensive diagnostic work-up. In a Danish study of 1429 patients abdominal pain was reported by 34% at a median 4.7 years after Roux-en-Y gastric bypass (RYGB)(1). In another Danish national cohort study of 9985 patients 24% were admitted to the hospital for surgical complications up to 4.2 years after RYGB; 15% for abdominal pain (2). According to a Swedish register study of 28,331 patients the rate of all cause hospital admission and for gastrointestinal surgery during 6 years of
follow-up after RYGB was 66% and 24%, respectively. The risk for gastrointestinal hospital admission was significantly increased compared to a matched population (3). In another study 34% of the patients reported chronic abdominal pain 5 years after RYGB (4). Increased rates of gastrointestinal symptoms compared to controls have also been reported by others (5). Recent data indicate that abdominal symptoms and gastrointestinal surgery are common after RYGB. The Swedish registry study illustrates the need for prolonged follow-up for evaluation of side effects as the rate of gastrointestinal surgery continued to increase during the 6 year study period (3). These aspects should be incorporated in preoperative guidance and selection of patients, and in follow-up consultations. Comparative studies focusing on these issues may facilitate decisions in regard to choice of procedure. Interestingly, most patients appear to report improved wellbeing after RYGB despite a number of reported symptoms (1). Gastrointestinal side effects should be part of future revisions of guidelines for use of bariatric surgery. Preferably, revised guidelines should be based on holistic evaluations of long-term outcome including exploration of outcome for subgroups of patients and the type of procedure performed.
References 1. Gribsholt SB, Pedersen AM, Svensson E, Thomsen RW, Richelsen B. Prevalence of Selfreported Symptoms After Gastric Bypass Surgery for Obesity. JAMA Surg. 2016;151:504-11. 2. Gribsholt SB, Svensson E, Richelsen B, Raundahl U, Sørensen HT, Thomsen RW. Rate of Acute Hospital Admissions Before and After Roux-en-Y Gastric Bypass Surgery: A Population-based Cohort Study. Ann Surg. 2016 Dec 16. In press. 3. Bruze G, Ottosson J, Neovius M, Näslund I, Marsk R. Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up. Surg Obes Relat Dis. 2017 Jan 5. In press. 4. Høgestøl IK, Chahal-Kummen M, Eribe I, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity. Obes Surg. 2016 Dec 27. In press. 5. Boerlage TC, van de Laar AW, Westerlaken S, Gerdes VE, Brandjes DP. Gastrointestinal symptoms and food intolerance 2 years after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Br J Surg. 2017;104:393-400.
www.elsevier.com/locate/buildenv
PII: DOI: Reference:
S1550-7289(17)30140-5 http://dx.doi.org/10.1016/j.soard.2017.03.009 SOARD2964
To appear in: Surgery for Obesity and Related Diseases Cite this article as: Tom Mala and Jon Kristinsson, Gastrointestinal symptoms after bariatric surgery - More focus needed, Surgery for Obesity and Related Diseases, http://dx.doi.org/10.1016/j.soard.2017.03.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter to Editor SOARD
Gastrointestinal symptoms after bariatric surgery - more focus needed
Tom Mala, MD, PhD Jon Kristinsson, MD, PhD Dep. of Morbid Obesity and Bariatric Surgery and Dep. of Gastrointestinal Surgery Oslo University Hospital Oslo, Norway
Corresponding Author; Tom Mala Dep. of Gastrointestinal Surgery, Ullevål Oslo University Hospital Kirkeveien 166, 0450 Oslo Norway e-mail; [email protected] Telephone; +47 92458235
Surg Obes Relat Dis; Letter to Editor
Beneficial short and long-term effects of bariatric surgery are well documented. Less is known about long-term side effects and adverse events. The 1991 recommendations for performing bariatric surgery are founded on limited evidence of long-term effects of contemporary procedures. Acceptance of side effects related to bariatric surgery may vary for health care providers and the individual patient according to factors such as presence of serious obesity related comorbidities or not, or degree of obesity. The total burden of side effects may vary according to type of procedure. Bariatric surgery for patients with body mass index <35 kg/m2 may be beneficial for many, but the benefits may be less obvious for subgroups of patients. A long-term aspect of bariatric surgery less focused on is abdominal pain and discomfort. It should be no surprise that such symptoms occur. Common causes include gall stone disease, internal herniation, gastrointestinal acid or bile reflux, anastomotic ulcers, and symptoms such as dumping and food intolerance. The etiology of symptoms may not always be defined despite extensive diagnostic work-up. In a Danish study of 1429 patients abdominal pain was reported by 34% at a median 4.7 years after Roux-en-Y gastric bypass (RYGB)(1). In another Danish national cohort study of 9985 patients 24% were admitted to the hospital for surgical complications up to 4.2 years after RYGB; 15% for abdominal pain (2). According to a Swedish register study of 28,331 patients the rate of all cause hospital admission and for gastrointestinal surgery during 6 years of
follow-up after RYGB was 66% and 24%, respectively. The risk for gastrointestinal hospital admission was significantly increased compared to a matched population (3). In another study 34% of the patients reported chronic abdominal pain 5 years after RYGB (4). Increased rates of gastrointestinal symptoms compared to controls have also been reported by others (5). Recent data indicate that abdominal symptoms and gastrointestinal surgery are common after RYGB. The Swedish registry study illustrates the need for prolonged follow-up for evaluation of side effects as the rate of gastrointestinal surgery continued to increase during the 6 year study period (3). These aspects should be incorporated in preoperative guidance and selection of patients, and in follow-up consultations. Comparative studies focusing on these issues may facilitate decisions in regard to choice of procedure. Interestingly, most patients appear to report improved wellbeing after RYGB despite a number of reported symptoms (1). Gastrointestinal side effects should be part of future revisions of guidelines for use of bariatric surgery. Preferably, revised guidelines should be based on holistic evaluations of long-term outcome including exploration of outcome for subgroups of patients and the type of procedure performed.
References 1. Gribsholt SB, Pedersen AM, Svensson E, Thomsen RW, Richelsen B. Prevalence of Selfreported Symptoms After Gastric Bypass Surgery for Obesity. JAMA Surg. 2016;151:504-11. 2. Gribsholt SB, Svensson E, Richelsen B, Raundahl U, Sørensen HT, Thomsen RW. Rate of Acute Hospital Admissions Before and After Roux-en-Y Gastric Bypass Surgery: A Population-based Cohort Study. Ann Surg. 2016 Dec 16. In press. 3. Bruze G, Ottosson J, Neovius M, Näslund I, Marsk R. Hospital admission after gastric bypass: a nationwide cohort study with up to 6 years follow-up. Surg Obes Relat Dis. 2017 Jan 5. In press. 4. Høgestøl IK, Chahal-Kummen M, Eribe I, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity. Obes Surg. 2016 Dec 27. In press. 5. Boerlage TC, van de Laar AW, Westerlaken S, Gerdes VE, Brandjes DP. Gastrointestinal symptoms and food intolerance 2 years after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Br J Surg. 2017;104:393-400.