Does Gastro-intestinal Quality of Life Improve After Gastric Bypass?

Nayna Lodhia, BS, Jaffer Kattan, BS, Adam Eltorai, BS, Homero Rivas, MD, John M Morton, MD MPH. Stanford

Introduction: Morbid obesity is the leading public health crisis in the United States and laparoscopic Roux-en-Y-gastric Bypass (LRYGB) is an effective and enduring weight-loss intervention. The purpose of this study was to analyze changes in quality of life of patients using the Gastrointestinal Quality of Life Questionnaire (GI-QoL).

Methods and Procedures: Demographic, preoperative, three, six and twelve month postoperative data were prospectively obtained for 196 consecutive laparoscopic RNYGB patients at a single academic institution. At each clinic visit, patients completed the GI-QoL, a 36 item questionnaire that analyzes GI symptoms, emotional status, physical and social performance, and stress of medical treatment with higher scores indicating better quality of life. Patients were compared on the basis of gender and body-mass index (BMI). Demographic, preoperative, and postoperative data were compared with GI-QoL scores with a one way ANOVA for continuous variables and chi-squared analysis for dichotomous variables using Stata/IC 11.1 software.

Results: 129 patients had 12 month postop data. Patient demographics included an average BMI 47, age 47, 67% white, income $62,000, 79% with private insurance, and 4 total preoperative comorbidities. Major comorbidities were diabetes (42%), hypertension (70%), hyperlipidemia (53%), GERD (43%), sleep apnea (48%), and depression (39%). Patients with depression had a lower overall preoperative GI-QoL score (p<0.001) compared to those without depression; however, the twelve month postoperative total GI-QoL had a less significant difference between those with and without depression (p<0.07). Men had significantly better results in nearly all preoperative GI-QoL categories: emotional status QoL (p=0.04), physical symptoms (p=0.003), medical treatment stress (p=0.02), disease specific stress (p=0.01), digestive health (p=0.023) and total score (p=0.002). However; these differences were not significant twelve months postoperative. A preoperative BMI above 50 trended towards a lower preoperative total QoL score (p=0.096), and a significantly lower depression sub-score (p=0.055); however these trends were not apparent at 12 months. Patients with surgical complications had a significantly lower preoperative and three month total GI-QoL score than those without surgical complications (p=0.02 and p<0.001, respectively). At 6 months there was a trend for lower quality of life in these patients (p=0.07), and by 12 months there was no significant GI-QoL difference in patients with surgical complications. Total GI-QoL scores increased postoperatively; however, the most significant increase was seen between preoperative and three month postoperative values (p<0.001), with less significant changes at six and twelve months.

Conclusions: This study demonstrates that LRYGB increases the overall gastrointestinal quality of life almost immediately after surgery. Furthermore, LRYGB results in comparable total quality of life at 12 months postop in patients regardless of their gender, preoperative depression diagnosis, surgical complications and BMI. A low initial total GI-QoL score may be predictive of a risk for surgical complication and further study is required.

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