Prevalence and impact of acid-related symptoms and diarrhea inpatients undergoing Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

Abstract

Gastrointestinal symptoms are common in the obese population. To determine the prevalence and importance of acid-related symptoms and diarrhea in 3 different types of bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD/DS). National data from Sweden. A total of 58,823 primary bariatric procedures (RYGB: 87.5%, SG: 11.7%, and BPD/DS:.7%) performed from 2007 to 2017 were identified in the Scandinavian Obesity Surgery Registry. Associations between acid-related symptoms and diarrhea, both defined by continuous use of pharmacologic treatment, and predefined outcomes were studied in a multivariate model, adjusted for age, sex, body mass index, and year of surgery. At baseline, acid-related symptoms were most common in RYGB (9.9%), while diarrhea was rare. In general, symptomatic patients were older, had more co-morbidities, and scored lower on quality of life compared with the remaining patients. In the multivariate analysis, RYGB patients with acid-related symptoms had reduced risk of prolonged operative time and length of stay, while postoperative complications and reoperations increased by 24% and 36%, respectively. In SG, both symptoms were associated with prolonged operative time and a doubled risk for complications. Symptomatic patients had reduced improvement in quality of life, while no association with the weight result was seen. Postoperatively, acid-related symptoms decreased in RYGB, while doubling in SG. Diarrhea increased 2- and 6-fold in RYGB and BPD/DS, respectively. The 2 gastrointestinal symptoms were associated with increased operative risks and reduced improvement in quality of life. Postoperatively, the respective anatomic alternations affected both gastrointestinal symptoms.