Change in gastrointestinal symptoms over the first 5 years after bariatric surgery in a multicenter cohort of adolescents

J Pediatr Surg. 2019 Jun;54(6):1220-1225. doi: 10.1016/j.jpedsurg.2019.02.032. Epub 2019 Feb 28.

Abstract

Background: Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are effective for weight loss in adolescents with severe obesity. However, little is known about adverse gastrointestinal symptoms (GIS) following these operations in adolescents. The objective was to examine GIS over 5 years after surgery and differences by surgery type.

Methods: We prospectively studied 228 adolescents (161 RYGB, 67 VSG) undergoing bariatric surgery. Gastrointestinal symptoms were assessed before surgery, at 6-months, and yearly to 5 years after surgery. Symptom severity was dichotomized for analysis. Analysis of post-surgery symptoms involved linear models adjusting for baseline symptoms, BMI, early post-operative complication, sex, and race.

Results: Participants at surgery were 17 ± 1.6 years with preoperative BMI 53 ± 9.4 kg/m2. From 6 months to 5 years, gastroesophageal reflux symptoms (GERS), nausea, bloating, and diarrhea increased. Crude prevalence rates of GERS increased from 4% (1% RYGB, 11% VSG) at 6-months post-surgery to 14% (10% RYGB, 26% VSG) at 5-years. In adjusted analyses, the VSG group experienced 4-fold (4.85 95% CI 2.63, 8.91, p < 0.0001) greater odds of GERS compared to RYGB.

Conclusions: Adolescents who underwent VSG experienced greater risk of GERS compared to those undergoing RYGB. Adolescents undergoing VSG should be counseled preoperatively about GERS and objectively monitored postoperatively for gastroesophageal reflux when indicated.

Clinical trial registration: ClinicalTrials.gov, Identifier: NCT00474318, https://clinicaltrials.gov/ct2/show/NCT00474318?term=Teen-LABS&rank=1.

Type of study: Treatment Study.

Level of evidence: Level II.

Keywords: Adolescent; Bariatric surgery; Gastrointestinal symptoms; Obesity.

MeSH terms

  • Adolescent
  • Gastrectomy* / adverse effects
  • Gastrectomy* / statistics & numerical data
  • Gastric Bypass* / adverse effects
  • Gastric Bypass* / statistics & numerical data
  • Gastrointestinal Diseases / epidemiology*
  • Humans
  • Postoperative Complications / epidemiology*
  • Prospective Studies

Associated data

  • ClinicalTrials.gov/NCT00474318