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Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity

Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for prevention.

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Introduction

For patients with morbid obesity, bariatric surgery, including Roux-en-Y gastric bypass (RYGB) surgery, is an effective treatment for weight loss and diseases associated with obesity.1,2 However, various medical, nutritional, and surgical symptoms requiring treatment may occur after RYGB surgery3– 5 and may impair patients’ quality of life (QoL). These symptoms have generally been classified as surgical or medical and nutritional depending on the primary treatment procedures. Common surgical symptoms after RYGB surgery include gallstones (7%-16% after 18-26 months’ follow-up)6,7 and kidney stones (≤8% after 19-42 months’ follow-up).8 Well-known medical and nutritional symptoms include dumping syndrome (12%-42% after 1-2 years),9– 11 hypoglycemia (0.2% of patients were hospitalized within 0-20 years),12 diarrhea (18% of patients with anal leakage of stool potentially provoked by diarrhea after 2 years),13peripheral neuropathy (16% of patients, with unknown follow-up period),14 and anemia (23%-47% after 24-48 months).15– 17 Commonly observed symptoms in clinical practice, such as abdominal pain and fatigue, are sparsely described in the literature on RYGB surgery despite the importance of such symptoms for patients’ functional status and QoL.18,19 Thus, a large population-based study with long-term follow-up of patients who had undergone RYGB surgery,providing a more comprehensive examination of symptom prevalence, is warranted.

Knowledge of possible predictors is important to prevent symptoms related to RYGB surgery after the procedure. Most patients undergoing RYGB surgery are women; recent studies have pointed toward a higher risk of hospitalization after RYGB surgery for women than for men,20,21 whereas others have found no influence of sex on the rate of hospitalization after the procedure.22Furthermore, advanced age has been associated with increased risk of hospitalization after surgery.20,21,23 Increased mortality and morbidity after other types of surgery has been observed for smokers,24 unmarried patients,25and unemployed persons.26 Whether such demographic and lifestyle factors also predict symptoms after bariatric surgery, to our knowledge, have not yet been examined.

Previous studies have reported improved physical QoL but not mental QoL after bariatric surgery.27,28 The influence of medical and nutritional symptoms on QoL after RYGB surgery has, to our knowledge, not been examined previously. As surgical symptoms have been associated with reduced QoL,29 we hypothesized that patients with medical and nutritional symptoms following RYGB surgery have a poorer QoL than do patients with no symptoms.

We aimed to conduct a comprehensive study of the well-being and the severity and burden of common symptoms after RYGB surgery. Furthermore, we examined possible predictors of symptoms requiring health care contact after RYGB surgery, including demographic, clinical, socioeconomic, and lifestyle factors. Finally, we examined the association of medical, nutritional, and surgical symptoms with QoL after RYGB surgery.

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