Abstract
BackgroundBariatric procedures are increasingly being used to combat the rising obesity epidemic. The aim of this study was to assess the effect of these interventions on bowel habit.MethodsWe recruited obese adults listed for a bariatric procedure. Demographic data, medical history, medications and anthropometric measurements were recorded. Bowel habit was characterized using a 7-day Bristol Stool Form Scale (BSFS) diary. A validated food frequency questionnaire (FFQ) was used to assess diet.ResultsTwenty-six patients were assessed pre-operatively and at a median of 6.4 months post-operatively. Nineteen had a Roux-en-Y gastric bypass (RYGB), five had a sleeve gastrectomy (SG) and two had an intra-gastric balloon (IGB) with median percentage excess weight loss (% EWL) of 67.9, 52.4 and 31.3 %, respectively. Dietary fibre intake decreased from 24.4 (±12.1) g/day pre-operatively to 17.5 (±7.3) g/day post-operatively (P = 0.008). Frequency of bowel motions decreased from 8.6 (±3.5) to 5.7 (±3.5) motions/week (P = 0.001). Mean usual BSFS score decreased (towards firmer stool) from 4.1 (±1.3) pre-operatively to 3.1 (±1.9) post-operatively (P = 0.016). Constipation increased from 8 to 27 %, but this did not reach statistical significance (P = 0.125).ConclusionsConstipation is a common problem after bariatric surgery. The decrease in bowel motion frequency and change towards firmer stools suggest prolonged intestinal transit time after bariatric procedures. Reduction in dietary fibre intake is likely to be a contributory factor.
Highlights
Obesity itself is associated with disordered bowel habit with most studies showing increased prevalence of diarrhoea, but not constipation in obese patients [3, 6]
One hypothesis is that high intake of sugars and other products in excess of absorption capability leads to an osmotic diarrhoea [1]
This study shows that constipation is a common problem after bariatric surgery with over a quarter of patients affected at 6 months follow-up
Summary
Whilst lifestyle-based interventions are the backbone of most public health strategies to prevent and treat obesity, bariatric procedures are increasingly being used to combat this rising epidemic. These interventions have significant benefits in terms of achieving sustained weight loss and improvement of obesity-related comorbidities [2]. Obesity itself is associated with disordered bowel habit with most studies showing increased prevalence of diarrhoea, but not constipation in obese patients [3, 6]. This increased prevalence of diarrhoea is likely to be multifactorial and is likely to be related to diet. The aim of this study was to assess the effect of these interventions on bowel habit
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