MNT Article Review

Gastrointestinal symptoms and eating behavior among morbidly obese patients undergoing
Roux-en-Y gastric bypass
Elizabeth A. Chevrette
Russell Sage College
April 2015

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Obesity is a growing problem, indicated by a BMI greater than 30. This is a condition
that has been shown to lower the quality of life (QOL) and increase the risk of developing many
other conditions including but not limited to esophagitis, gastritis, hiatal hernia, and gastro
esophageal reflux disease (GERD).1 GERD is a backward flow of gastric or duodenal juices
from the stomach or duodenum into the esophagus which, when left untreated, can lead to
esophagitis.2 The Roux-en-Y gastric bypass (RYGB) is a surgical procedure performed on those
who fail to lose weight on their own and are able to complete a patient evaluation ensuring they
are appropriate candidates for this approach to weight loss.2 The procedure changes the anatomy
and physiology of the gastrointestinal (GI) tract,1 causing malabsorptive weight loss.2 This
procedure is normally performed when it is necessary for a patient to lose weight, or as an
attempt to alleviate certain medical conditions such as GERD. The study Gastrointestinal
symptoms and eating behavior among morbidly obese patients undergoing Roux-en-Y gastric
bypass, was performed by the Lithuanian University of Health Sciences Department of Surgery,
and aimed to look at the effects RYGB has on GI symptoms, eating behavior, and bowel function
in a population of morbidly obese patients.1
RYGB has proven to be an effective way to sustain long-term weight loss and reduce acid
reflux by reducing secretion levels of the stomachs small gastric pouch.2 For this study, 180
morbidly obese patients (52 males and 128 females) between the ages of 18 to 65 years of age
with either a BMI of 40 or more, or a BMI of 35 or greater with at least one other comorbidity1,2
were selected to be evaluated. These patients underwent a gastroscopy, a RYGB, and had their
symptoms evaluated both before and one year after the RYGB by using a Gastroesophagel
Reflux Disease-Health Related Quality of Life (GERD-HRQL), a

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Gastrointestinal Symptom Rating Scale (GSRS), and a Three-Factor Eating Questionnaire to
evaluate eating behavior. 1
Of the 180 participants, preoperative endoscopy revealed that 49 had preexisting
esophagitis, 61 had gastritis, 37 had hiatal hernia, and 108 had H. pylori infection. Though H.
pylori infection was so prevalent, none of the patients involved were found to have peptic ulcers
or gastric cancer. One year after RYGB, the average BMI decreased from an average of 45 to an
average of 31, 1 moving these patients from morbidly obese to borderline obese. Post operative
success was measured by evaluating remaining GI symptoms and eating behavior, which
included cognitive restraint, uncontrolled eating, and emotional eating. All eating behaviors as
well as GI symptoms were found to decrease significantly after RYGB, with the exception of
diarrhea. Postoperative BMIs were found to correlate more with age and waist circumference of
patients undergoing RYGB than with GERD scores, GI symptoms, and eating behavior. GERDHRQL scores were not found to have significant correlation to BMI or waist circumference
before or after surgery.1Contrary to the findings of other similar studies, cognitive restraint in this
population was found to increase considerably one year post-RYGB while uncontrolled eating
and emotional eating decreased. This study concluded that there was a correlation between GI
discomfort and endoscopic findings, as well as the conclusion that RYGB reduces GI discomfort
and eating behavior one year after surgery.1
Gastric surgeries are becoming more common in todays population2. This study
examined the symptoms and eating behaviors of a sample of obese individuals undergoing
RYGB. Symptoms such as GERD and hiatal hernia are more frequently associated with a higher

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BMI. The hope was that undergoing bariatric surgery would have a positive effect on GERD,
esophagitis, gastirits, hiatal hernia, and H. pylori. The key in reducing GERD and other
esophageal discomfort is to reduce acid secretion, which may be accomplished with a RYGB.
Hiatal hernias contribute to the onset of GERD and its symptoms, which in turn can cause
esophagitis, showing reasoning behind why these patients were found to have such high
prevalence of these issues. Weight reduction is one of the best ways to reduce the likelihood and
complications of a hiatal hernia.2 Though RYGB is an option for weight loss and studies have
found positive effects from this approach , there is also proof of natural weight loss providing
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similar benefits. Though recent research has found evidence that RYGB has a positive effect on
reducing weight and many GI issues, evidence also suggests that weight is not the only
contributor to this issue, and RYGB did not alleviate all discomfort as diarrhea persisted after
surgery. An obese patient that loses 5-10% of their body weight is able to greatly improve their
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short term health without undergoing surgery . RYGB is one option for obese patients that have
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failed to lose weight, or those that suffer from GERD, esophagitis, and other weight related side
effects, but it is not the only option for those who want relief. The one year post RYGB feedback
from patients involved was lower than researchers had hoped and due to the possibility that those
who did not give feedback did not experience as much success from the operation, it is possible
that these results were skewed. 1

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Works Cited
1. Petereit, R., Jonaitis, L., Kupcinskas, L. Maleckas, A. (27 June 2014). Gastrointestinal
symptoms and eating behavior among morbidly obese patients undergoing Rouxen-Y gastric bypass. Medicina, 50 (2014), 118-123. Science Direct.
http://www.sciencedirect.com/science/article/pii/S1010660X14000263
2. Mahan, K., Escott-Stump, S., Raymond, J. (2012). Krauses Food and the Nutrition Care

Process. 13th edition. St. Louis, Missouri: Elsevier.