Elsevier

Surgery for Obesity and Related Diseases

Volume 9, Issue 5, September–October 2013, Pages 641-647
Surgery for Obesity and Related Diseases

Original article
Gastrointestinal function and eating behavior after gastric bypass and duodenal switch

Presented at the 87th Annual Meeting of the Norwegian Surgical Association, Oslo, Norway, October 2011.
https://doi.org/10.1016/j.soard.2012.06.006Get rights and content

Abstract

Background

Duodenal switch provides greater weight loss than gastric bypass in severely obese patients; however, comparative data on the changes in gastrointestinal symptoms, bowel function, eating behavior, dietary intake, and psychosocial functioning are limited.

Methods

The setting for the present study was 2 university hospitals in Norway and Sweden. Participants with a body mass index of 50–60 kg/m2 were randomly assigned to gastric bypass (n = 31) or duodenal switch (n = 29) and followed up for 2 years. Of the 60 patients, 97% completed the study. Their mean weight decreased by 31.2% after gastric bypass and 44.8% after duodenal switch. At inclusion and 1 and 2 years of follow-up, the participants completed the Gastrointestinal Symptom Rating Scale, a bowel function questionnaire, the Three-Factor Eating Questionnaire-R21, a 4-day food record, and the Obesity-related Problems scale.

Results

Compared with the gastric bypass group, the duodenal switch group reported more symptoms of diarrhea (P = .0002), a greater mean number of daytime defecations (P = .007), and more anal leakage of stool (50% versus 18% of participants, respectively; P = .015) after 2 years. The scores for uncontrolled and emotional eating were significantly and similarly reduced after both operations. The mean total caloric intake and intake of fat and carbohydrates were significantly reduced in both groups. Protein intake was significantly reduced only after gastric bypass (P = .008, between-group comparison). Psychosocial function was significantly improved after both operations (P = .23, between the 2 groups).

Conclusion

Gastrointestinal side effects and anal leakage of stool were more pronounced after duodenal switch than after gastric bypass. Both procedures led to reduced uncontrolled and emotional eating, reduced caloric intake, and improved psychosocial functioning.

Section snippets

Methods

The present study was conducted at Oslo University Hospital Aker (Oslo, Norway) and Sahlgrenska University Hospital (Gothenburg, Sweden). The study design, inclusion and exclusion criteria, a study flow diagram, and detailed descriptions of the operations have been previously reported [7], [8], [10]. The appropriate local ethics committees approved the study protocol, which was registered at http://ClinicalTrials.gov (registration number NCT00327912).

Results

No significant differences were found between the 2 groups in any outcome measure at baseline.

Discussion

In the present 2-year randomized trial, duodenal switch was associated with more symptoms of diarrhea, more frequent defecations at daytime, and more anal leakage of stool than was gastric bypass. The changes in the other gastrointestinal symptoms and bowel habits, eating behavior, caloric intake, and psychosocial functioning were broadly similar between the procedures. Thus, patients with severe obesity choosing gastric bypass or duodenal switch should be informed about the potential

Conclusion

Both gastric bypass and duodenal switch were associated with gastrointestinal side effects, but these symptoms were more pronounced after the duodenal switch. Psychosocial function improved similarly, and both groups had significant reductions in uncontrolled and emotional eating and a reduced mean total caloric intake.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (36)

  • E.J. DeMaria

    Bariatric surgery for morbid obesity

    N Engl J Med

    (2007)
  • C.W. le Roux et al.

    Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass

    Ann Surg

    (2007)
  • M. Bueter et al.

    Gastric bypass increases energy expenditure in rats

    Gastroenterology

    (2010)
  • T. Olbers et al.

    Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial

    Ann Surg

    (2006)
  • A.D. Miras et al.

    Bariatric surgery and taste: novel mechanisms of weight loss

    Curr Opin Gastroenterol

    (2010)
  • D.R. Flum et al.

    Perioperative safety in the longitudinal assessment of bariatric surgery

    N Engl J Med

    (2009)
  • T.T. Søvik et al.

    Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial

    Ann Intern Med

    (2011)
  • T.T. Søvik et al.

    Randomized clinical trial of laparoscopic gastric bypass versus laparoscopic duodenal switch for superobesity

    Br J Surg

    (2010)
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    Supported by research grants from the South-Eastern Norway Regional Health Authority and Sahlgrenska University Hospital.

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