Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up



      Having accurate information on bariatric surgery-related gastrointestinal (GI) symptoms is critical for patient care.


      To report on surgery-related GI symptoms over the first 3 years following Roux-en-Y gastric bypass and laparoscopic adjustable gastric band.


      Three academic medical centers in the United States.


      As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 183 participants (pre-surgery median body mass index = 45.1 kg/m2; median age = 46 yr; 83.1% female). completed the Eating Disorder Examination-Bariatric Surgery Version interview at≥1 annual assessment. Patients self-reported frequency of dysphagia, dumping syndrome, and spontaneous vomiting.


      Prevalence of dysphagia at least once weekly decreased post-laparoscopic adjustable gastric band surgery from 43.9% (95% confidence interval [CI], 32.2–55.6) in year 1 to 27.5% (95% CI, 15.2–39.9) in year 3 (P = .02). Dysphagia and dumping at least once weekly also appeared to decrease in years 1–3 post-Roux-en-Y gastric bypass (i.e., from 16.7% [95% CI, 9.4–24.1] to 10.9% [95% CI, 4.0–17.8] and from 9.9% [95% CI, 4.3–15.5] to 6.3% [95% CI, 1.7–10.9], respectively), but power was limited to evaluate trends. Vomiting at least once weekly was rare (<6%) in years 1–3 following both procedures. Controlling for potential confounders and surgical procedure, loss of control eating at least once weekly was associated with higher risk of at least once weekly dysphagia (relative risk = 2.01, 95% CI, 1.36–2.99, P = .001).


      The prevalence of bariatric surgery-related GI symptoms appears to decrease across follow-up. Symptoms were associated with loss of control eating, suggesting a target for clinical intervention.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lee W.J.
        • Lee M.H.
        • Yu P.J.
        • et al.
        Gastro-intestinal quality of life after metabolic surgery for the treatment of type 2 diabetes mellitus.
        Obes Surg. 2015; 25: 1371-1379
        • Yu P.J.
        • Tsou J.J.
        • Lee W.J.
        • Lee K.T.
        • Lee Y.C.
        Impairment of gastrointestinal quality of life in severely obese patients.
        World J Gastroenterol. 2014; 20: 7027-7033
        • Burton P.R.
        • Ooi G.J.
        • Laurie C.
        • et al.
        Changes in outcomes, satiety and adverse upper gastrointestinal symptoms following laparoscopic adjustable gastric banding.
        Obes Surg. 2017; 27: 1240-1249
        • de Zwaan M.
        • Hilbert A.
        • Swan-Kremeier L.
        • et al.
        Comprehensive interview assessment of eating behavior 18-35 months after gastric bypass surgery for morbid obesity.
        Surg Obes Relat Dis. 2010; 6: 79-85
        • Kalarchian M.A.
        • Marcus M.D.
        • Courcoulas A.P.
        • Cheng Y.
        • Levine M.D.
        Self-report of gastrointestinal side effects after bariatric surgery.
        Surg Obes Relat Dis. 2014; 10: 1202-1207
        • Mallory G.N.
        • Macgregor A.M.
        • Rand C.S.
        The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity.
        Obes Surg. 1996; 6: 474-478
        • Banerjee A.
        • Ding Y.
        • Mikami D.J.
        • Needleman B.J.
        The role of dumping syndrome in weight loss after gastric bypass surgery.
        Surg Endosc. 2013; 27: 1573-1578
        • Berg P.
        • McCallum R.
        Dumping syndrome: A review of the current concepts of pathophysiology, diagnosis, and treatment.
        Dig Dis Sci. 2016; 61: 11-18
        • Tack J.
        • Deloose E.
        Complications of bariatric surgery: Dumping syndrome, reflux and vitamin deficiencies.
        Best Pract Res Clin Gastroenterol. 2014; 28: 741-749
        • Borovicka J.
        • Krieger-Grübel C.
        • van der Weg B.
        • et al.
        Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function.
        Surg Endosc. 2017; 31: 552-560
        • Rogers A.M.
        Improvement of esophageal dysmotility after conversion from gastric banding to gastric bypass.
        Surg Obes Relat Dis. 2010; 6: 681-683
        • Nath A.
        • Yewale S.
        • Tran T.
        • Brebbia J.S.
        • Shope T.R.
        • Koch T.R.
        Dysphagia after vertical sleeve gastrectomy: Evaluation of risk factors and assessment of endoscopic intervention.
        World J Gastroenterol. 2016; 22: 10371-10379
        • Ardila-Hani A.
        • Soffer E.E.
        Review article: The impact of bariatric surgery on gastrointestinal motility.
        Aliment Pharmacol Ther. 2011; 34: 825-831
        • El Labban S.
        • Safadi B.
        • Olabi A.
        The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: A cross-sectional pilot study.
        Obes Surg. 2015; 25: 2393-2399
        • Meany G.
        • Conceição E.
        • Mitchell J.E.
        Binge eating, binge eating disorder and loss of control eating: Effects on weight outcomes after bariatric surgery.
        Eur Eat Disord Rev. 2014; 22: 87-91
        • Sugerman H.J.
        • Starkey J.V.
        • Birkenhauer R.
        A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.
        Ann Surg. 1987; 205: 613-624
        • Belle S.H.
        • Berk P.D.
        • Chapman W.H.
        • et al.
        • LABS Consortium
        Baseline characteristics of participants in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study.
        Surg Obes Relat Dis. 2013; 9: 926-935
        • Belle S.H.
        • Berk P.D.
        • Courcoulas A.P.
        • et al.
        • Longitudinal Assessment of Bariatric Surgery Consortium Writing Group
        Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery.
        Surg Obes Relat Dis. 2007; 3: 116-126
        • Courcoulas A.P.
        • Christian N.J.
        • Belle S.H.
        • et al.
        • Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
        Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity.
        JAMA. 2013; 310: 2416-2425
        • Flum D.R.
        • Belle S.H.
        • King W.C.
        • et al.
        • Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
        Perioperative safety in the Longitudinal Assessment of Bariatric Surgery.
        New Eng J Med. 2009; 361: 445-454
        • Fairburn C.G.
        • Cooper Z.
        The eating disorder examination. 12th ed.
        in: Fairburn C.G. Wilson G.T. Binge eating: Nature, assessment and treatment. Guilford Press, New York1993: 317-360
        • Delvin M.J.
        • King W.C.
        • Kalarchian M.A.
        • et al.
        Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up.
        Int J Eat Disorder. 2016; 49: 1058-1067
        • Sigstad H.
        A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal.
        Acta Med Scand. 1970; 188: 479-486
        • Christian N.J.
        • King W.C.
        • Yanovski S.Z.
        • Courcoulas A.P.
        • Belle S.H.
        Validity of self-reported weights following bariatric surgery.
        JAMA. 2013; 310: 2454-2456
        • Svedlund J.
        • Sjödin I.
        • Dotevall G.
        GSRS—A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease.
        Dig Dis Sci. 1988; 33: 129-134
        • SAS Institute Inc
        The MIXED procedure: The LSMEANS statement.
        SAS Institute Inc., Cary, NC2009
        • King W.C.
        • Chen J.Y.
        • Belle S.H.
        • et al.
        Change in pain and physical function following bariatric surgery for severe obesity.
        JAMA. 2016; 315: 1362-1371
        • Loss A.B.
        • de Souza A.A.
        • Pitombo C.A.
        • Milcent M.
        • Madureira F.A.
        Analysis of the dumping syndrome on morbid obese patients submitted to Roux en Y gastric bypass [in Portuguese].
        Rev Col Bras Cir. 2009; 36: 413-419
        • Sarwer D.B.
        • Moore R.H.
        • Spitzer J.C.
        • Wadden T.A.
        • Raper S.E.
        • Williams N.N.
        A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery.
        Surg Obes Relat Dis. 2012; 8: 561-568
        • Mitchell J.E.
        • Lancaster K.L.
        • Burgard M.A.
        • et al.
        Long-term follow-up of patients’ status after gastric bypass.
        Obes Surg. 2001; 11: 464-468
        • Emous M.
        • Ubels F.L.
        • van Beek A.P.
        Diagnostic tools for post-gastric bypass hypoglycaemia.
        Obes Rev. 2015; 16: 843-856
        • Papamargaritis D.
        • Koukoulis G.
        • Sioka E.
        • et al.
        Dumping symptoms and incidence of hypoglycaemia after provocation test at 6 and 12 months after laparoscopic sleeve gastrectomy.
        Obes Surg. 2012; 22: 1600-1606
        • Laurenius A.
        • Werling M.
        • Le Roux C.W.
        • Fändriks L.
        • Olbers T.
        More symptoms but similar blood glucose curve after oral carbohydrate provocation in patients with a history of hypoglycemia-like symptoms compared to asymptomatic patients after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2014; 10: 1047-1054