Skip to main content

Advertisement

SpringerLink
Log in

Characterization of Self-Reported Dysphagia and Impact on Weight Outcomes After Laparoscopic Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction/Aims

There is paucity of literature examining dysphagia after laparoscopic sleeve gastrectomy (LSG). Moreover, there are few validated scoring systems for dysphagia that adequately assess its psychosocial impact. We aim to investigate dysphagia after LSG using a multidimensional scale that examines its functional and emotional impact. As secondary aims, we evaluated the impact of dysphagia on weight outcomes and its relationship with pre-operative gastro-esophageal reflux disease (GERD) and proton pump inhibitor (PPI) use.

Methods

One hundred twenty-four patients 1 year or more post-LSG were administered the validated Dysphagia Handicap Index (DHI) questionnaire. To further delineate esophageal dysphagia, three additional questions were added. One hundred one patients (81.5%) responded. Physical, Emotional, Functional, and Esophageal scales were analyzed combined and individually using a multivariate model.

Results

No patients reported dysphagia pre-operatively. The median DHI scale scores are the following: Physical—2 (0–20); Functional—4 (0–22); Emotional—2 (0–14); and Esophageal—2 (0–8). On multivariate analysis, DHI Emotional scores significantly correlated with reduced total weight loss (%TWL) (p = 0.001) and excess weight loss (%EWL) (p = 0.023). The physical symptoms of dysphagia did not affect weight outcomes. Post-operatively, PPI usage increased significantly (15.8 vs 19.8%, p = 0.01) and correlated with higher dysphagia scores.

Conclusion

A statistically validated dysphagia-specific questionnaire was utilized to evaluate the impact of LSG on dysphagia including its functional and emotional influences. The psychosocial handicap of dysphagia significantly reduced weight loss outcomes. A correlation between PPI use and dysphagia after LSG was found. The prevalence of dysphagia after LSG and the factors that contribute to its symptoms need to be further studied.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ΔBMI:

change in BMI

References

  1. Bariatric Surgery Registry. Fifth Annual Report of the Bariatric Surgery Registry. Melbourne: Monash University, Melbourne, School of Public Health and Preventative Medicine; 2017. p. 39

  2. Overs SE, Freeman RA, Zarshenas N, et al. Food tolerance and gastrointestinal quality of life following three bariatric procedures: adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Obes Surg. 2012;22(4):563–43.

    Article  Google Scholar 

  3. Labban SE, Safadi B, Olabi A. The effect of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on dietary intake, food preferences, and gastrointestinal symptoms in post-surgical morbidly obese Lebanese subjects: a cross-sectional pilot study. Obes Surg. 2015;25(12):2393–9.

    Article  PubMed  Google Scholar 

  4. Carabotti M, Severi C, Leonetti F, et al. Upper gastrointestinal symptoms in obese patients and their outcomes after bariatric surgery. Expert Rev Gastroenterol Hepatol. 2013;7(2):115–26.

    Article  PubMed  CAS  Google Scholar 

  5. Fysekidis M, Bouchoucha M, Bihan H, et al. Prevalence and co-occurrence of upper and lower functional gastrointestinal symptoms in patients eligible for bariatric surgery. Obes Surg. 2012;22(3):403–10.

    Article  PubMed  Google Scholar 

  6. Carabotti M, Silecchia G, Greco F, et al. Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg. 2013;23(10):1551–7.

    Article  PubMed  Google Scholar 

  7. Nath A, Yewale S, Tran T, et al. Dysphagia after vertical sleeve gastrectomy: evaluation of risk factors and assessment of endoscopic intervention. World J Gastroenterol. 2016;22(47):10371–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Fysekidis M, Bouchoucha M, Bihan H, et al. Decreased prevalence of nonspecific functional bowel disorders and increased constipation in patients after sleeve gastrectomy or gastric banding. Bariatric Surg Prac Patient Care. 2016;11(4):158–64.

    Article  Google Scholar 

  9. Althuwaini S, Bamehriz F, Aldohayan A, et al. Predictors of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy. Obes Surg. 2017;28(916):1–7. https://doi.org/10.1007/s11695-017-2971-4.

    Article  Google Scholar 

  10. Moon RC, Teixeira AF, Jawad MA. Safety and effectiveness of anterior fundoplication sleeve gastrectomy in patients with severe reflux. Surg Obes Relat Dis. 2017;13(4):547–52.

    Article  PubMed  Google Scholar 

  11. Moon RC, Teixeira AF, Jawad MA. Is preoperative manometry necessary for evaluating reflux symptoms in sleeve gastrectomy patients? Surg Obes Relat Dis. 2015;11(3):546–51.

    Article  PubMed  Google Scholar 

  12. Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc. 2015;29(7):1760–8.

    Article  PubMed  Google Scholar 

  13. van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.

    Article  PubMed  Google Scholar 

  14. van Rutte PW, Smulders JF, de Zoete JP, et al. Sleeve gastrectomy in older obese patients. Surg Endosc. 2013;27(6):2014–9.

    Article  PubMed  Google Scholar 

  15. Basso N, Casella G, Rizzello M, et al. Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases. Surg Endosc. 2011;25(2):444–9.

    Article  PubMed  CAS  Google Scholar 

  16. Sabbagh C, Verhaeghe P, Dhahri A, et al. Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding. Obes Surg. 2010;20(6):679–84.

    Article  PubMed  Google Scholar 

  17. Casella G, Soricelli E, Giannotti D, et al. Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis. 2016;12(4):757–62.

    Article  PubMed  Google Scholar 

  18. Mizrahi I, Alkurd A, Ghanem M, et al. Outcomes of laparoscopic sleeve gastrectomy in patients older than 60 years. Obes Surg. 2014;24(6):855–60.

    Article  PubMed  Google Scholar 

  19. van Wezenbeek MR, van Oudheusden TR, de Zoete JP, et al. Conversion to gastric bypass after either failed gastric band or failed sleeve gastrectomy. Obes Surg. 2017 Jan;27(1):83–9. https://doi.org/10.1007/s11695-016-2249-2.

    Article  PubMed  Google Scholar 

  20. Vilallonga R, Himpens J, van de Vrande S. Laparoscopic management of persistent strictures after laparoscopic sleeve gastrectomy. Obes Surg. 2013 Oct;23(10):1655–61.

    Article  PubMed  Google Scholar 

  21. van Rutte PW, Smulders JF, de Zoete JP, et al. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg. 2012;22(12):1903–8.

    Article  PubMed  Google Scholar 

  22. Silbergleit AK, Schultz L, Jacobson BH, et al. The dysphagia handicap index: development and validation. Dysphagia. 2011;26(1):46–52.

    Article  Google Scholar 

  23. Vesey S. Dysphagia and quality of life. Br J Community Nurs. 2013 May;18(5):14–9.

    Article  Google Scholar 

  24. Gustafsson B, Tibbling L. Dysphagia, an unrecognized handicap. Dysphagia. 1991;6(4):193–9.

    Article  PubMed  CAS  Google Scholar 

  25. Mesallam T, Farahat M. Self-perception of swallowing-related problems in. Laryngopharyngeal reflux patients diagnosed with 24-hour oropharyngeal pH monitoring. BioMed Res Intl 2016 p. 4.

  26. Orlandoni P, Peladic NJ. Health-related quality of life and functional health status questionnaires in oropharyngeal dysphagia. J Aging Res Clin Practice. 2016;5(1):31–7.

    Google Scholar 

  27. Woisard V, Sordes F. Health related quality of life and oropharyngeal dysphagia. J Gastroenterol Hepatol Res. 2014;3(10):1292–300.

    Google Scholar 

  28. Denk-Linnert DM. Evaluation of symptoms. In: Medical radiology. Berlin: Springer; 2017. p. 1–11.

    Google Scholar 

  29. Taft TH, Riehl M, Sodikoff JB, et al. Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol Motil. 2016;28(12):1854–60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Grudell AB, Alexander JA, Enders FB, et al. Validation of the Mayo Dysphagia Questionnaire. Dis Esophagus. 2007;20(3):202–5.

    Article  PubMed  CAS  Google Scholar 

  31. McElhiney J, Lohse MR, Arora AS, et al. The Mayo Dysphagia Questionnaire-30: documentation of reliability and validity of a tool for interventional trials in adults with esophageal disease. Dysphagia. 2010;25(3):221–30.

    Article  PubMed  Google Scholar 

  32. D’Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011 Feb;25(8):2498–504.

    Article  PubMed  Google Scholar 

  33. Seo DC, Lee CG, Torabi MR, et al. The longitudinal trajectory of post-surgical % total weight loss among middle-aged women who had undergone bariatric surgery. Prev Med Rep. 2016;28(5):200–4.

    Google Scholar 

  34. Figura A, Ahnis A, Stengel A, Hofmann T, Elbelt U, Ordemann J, Rose M. Determinants of weight loss following laparoscopic sleeve gastrectomy: the role of psychological burden, coping style, and motivation to undergo surgery. J Obes 2015; p.10.

Download references

Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia

    Sukaina Jaffar & Michael Devadas

  2. Department of Bariatric Surgery and Upper Gastrointestinal Surgery, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia

    Michael Devadas

  3. Centre for Bariatric and Metabolic Surgery, Circle of Care – Institute of Weight Control, Hospital for Specialist Surgery, Sydney, NSW, Australia

    Michael Devadas

  4. Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Private Hospital, Sydney, NSW, Australia

    Michael Devadas

  5. Department of Upper Gastrointestinal Surgery and General Surgery, Norwest Private Hospital, Sydney, NSW, Australia

    Michael Devadas

  6. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Michael Devadas

Authors
  1. Sukaina Jaffar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Devadas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sukaina Jaffar.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Table 3 Items of the online dysphagia questionnaire administered to patients via Survey Monkey. The number shown indicates the number of patients that responded “never,” “sometimes,” or “always” to each item of the survey
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaffar, S., Devadas, M. Characterization of Self-Reported Dysphagia and Impact on Weight Outcomes After Laparoscopic Sleeve Gastrectomy. OBES SURG 28, 3177–3185 (2018). https://doi.org/10.1007/s11695-018-3293-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3293-x

Keywords

Search

Navigation