Obesity Surgery

, Volume 27, Issue 6, pp 1438–1445 | Cite as

Chronic Abdominal Pain and Symptoms 5 Years After Gastric Bypass for Morbid Obesity

  • Ingvild K. HøgestølEmail author
  • Monica Chahal-Kummen
  • Inger Eribe
  • Cathrine Brunborg
  • Audun Stubhaug
  • Stephen Hewitt
  • Jon Kristinsson
  • Tom Mala
Original Contributions



Roux-en-Y gastric bypass (RYGB) is widely performed as treatment of morbid obesity. Long-term weight loss, effects on co-morbidities, and quality of life after RYGB have been well addressed. Other long-term outcomes are less elucidated. The aim of this study was to evaluate the prevalence, symptom characteristics, and possible predictors of chronic abdominal pain and gastrointestinal symptoms during consultations 5 years after RYGB.


A 5-year follow-up study of patients operated with RYGB 2008–2009 was performed. The patients completed questionnaires regarding chronic abdominal pain, the Gastrointestinal Symptom Rating Scale (GSRS), the ROME III questionnaire, the Hospital Anxiety and Depression Scale, Pain Catastrophing Scale (PCS), the Brief Pain Inventory, and SF-36. Uni- and multivariable logistic regression analyses of characteristics associated with chronic abdominal pain were performed.


A total of 165/234 (71%) patients met to the follow-up, 160 of these accepted study inclusion. The mean follow-up was 64 (SD 4.2) months. The mean age was 42.5 (SD 8.7) years and 59% were females. The mean total weight loss was 23.9% (SD 11.2). Chronic abdominal pain was reported by 33.8%. Female gender, average strength of bodily pain, and the PCS sum score were associated with chronic abdominal pain. Symptoms of indigestion and irritable bowel syndrome were reported by 48.8% and 29.1%, respectively. Chronic abdominal pain was associated with reduced health related quality of life.


A substantial proportion of patients experienced chronic abdominal pain and symptoms 5 years after RYGB. Abdominal pain should be addressed at follow-up consultations after RYGB.


Bariatric surgery Gastric bypass Morbid obesity Abdominal pain Gastrointestinal symptoms Follow-up 



We deeply appreciate the support from Marianne Sæter and Irene Ruud Johannessen at the Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital for their assistance in patient recruitment and questionnaire retrieval. We also appreciate the financial support by the Norwegian Gastroenterology Association.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Stenberg E, Szabo E, Agren G, et al. Early complications after laparoscopic gastric bypass surgery. Ann Surg. 2014;260(6):1040–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Suter M, Donaldini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.CrossRefPubMedGoogle Scholar
  3. 3.
    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-y gastric bypass: 10- to 13-year data. Surg Obes Rel Dis. 2016;12(1):11–22.CrossRefGoogle Scholar
  5. 5.
    Aftab H, Risstad H, Sovik TT, et al. Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. Surg Obes Relat Dis. 2014;10(1):71–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Risstad H, Søvik TT, Hewitt S, et al. Changes in health-related quality of life after gastric bypass in patients with and without obesity-related disease. Obes Surg. 2015;25(12):2408–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Gribsholt SB, Pedersen AM, Svensson E, et al. Prevalence of self-reported symptoms after gastric bypass surgery for obesity. JAMA Surg. 2016;6:1–9.Google Scholar
  8. 8.
    Gralnek IM, Hays RD, Kilbourne A, et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119(3):654–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6(10):583–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Greenstein AJ, O’Rourke RW. Abdominal pain following gastric bypass: suspects and solutions. Am J Surg. 2011;201(6):819–27.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schauer PR, Ikramuddin S, Hamad G, et al. Laparoscopic gastric bypass surgery: current technique. J of Laparoendosc Adv Surg Tech A. 2003;13(4):229–39.CrossRefGoogle Scholar
  12. 12.
    Svedlund J, Sjödin I, Dotevall G. GSRS: a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci. 1988;33(2):129–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Ford AC, Bercik P, Morgan DG, et al. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gatroenterology. 2013;145:1262–70.CrossRefGoogle Scholar
  14. 14.
    Fernandes L, Storheim K, Lochting I, et al. Cross-cultural adaptation and validation of the Norwegian pain catastrophizing scale in patients with low back pain. BMC Musculoskelet Disord. 2012;13:111.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Klepstad P, Loge JH, Borchgrevink PC, et al. The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manag. 2002;24(5):517–25.CrossRefGoogle Scholar
  16. 16.
    Snaith RP, Zigmond AS. The hospital anxiety and depression scale. Br Med J (Clin Res Ed). 1986;292:344.CrossRefGoogle Scholar
  17. 17.
    Bjelland I, Dahl AA, Haug TT, et al. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77.CrossRefPubMedGoogle Scholar
  18. 18.
    Karlsen TI, Tveita EK, Natvig GK, et al. Validity of the SF-36 in patients with morbid obesity. Obes Facts. 2011;4(5):346–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Theunissen M, Peters ML, Bruce J, et al. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819–41.CrossRefPubMedGoogle Scholar
  20. 20.
    Stabell N, Stubhaug A, Flægstad T, et al. Widespread hyperalgesia in adolescents with symptoms of irritable bowel syndrome: results from a large population-based study. J Pain. 2014;15(9):898–906.CrossRefPubMedGoogle Scholar
  21. 21.
    Hinrichs-Rocker A, Schulz K, Jarvinen I, et al. Psychososial predictors and correlates for chronic post-surgical pain (CPSP)—a systematic review. Eur J Pain. 2009;13(7):719–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Nicoletti CF, de Oliveira BA, Barbin R, et al. Red meat intolerance in patients submitted to gastric bypass: a 4-year follow-up study. Surg Obes Relat Dis. 2015;11(4):842–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Rea JD, Yarbroughh DE, Leeth RR, et al. Influence of complications and extent of weight loss on quality of life after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21(7):1095–100.CrossRefPubMedGoogle Scholar
  24. 24.
    Aghajani E, Jacobsen HJ, Nergaard BJ, et al. Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg. 2012;16(3):641–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Bauman RW, Pirrello JR. Internal hernia at Petersen’s space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure—a single surgeon series of 1047 cases. Surg Obes Relat Dis. 2009;5(5):565–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Drury CA, Louis M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract. 2002;14(12):554–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Eriksen J, Jensen MK, Sjøgren P, et al. Epidemiology of chronic non-malignant pain in Denmark. Pain. 2003;106(3):221–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ingvild K. Høgestøl
    • 1
    • 2
    Email author
  • Monica Chahal-Kummen
    • 1
  • Inger Eribe
    • 1
  • Cathrine Brunborg
    • 3
  • Audun Stubhaug
    • 2
    • 4
  • Stephen Hewitt
    • 1
    • 2
  • Jon Kristinsson
    • 1
  • Tom Mala
    • 1
    • 5
  1. 1.Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
  2. 2.Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Oslo Centre for Biostatistics and Epidemiology, Research Support ServicesOslo University HospitalOsloNorway
  4. 4.Department of Pain Management and ResearchOslo University HospitalOsloNorway
  5. 5.Department of Gastrointestinal Surgery and Paediatric SurgeryOslo University HospitalOsloNorway

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