Long-term bariatric follow-up may curb anemia after gastric bypass

Reuters Health Information: Long-term bariatric follow-up may curb anemia after gastric bypass

Long-term bariatric follow-up may curb anemia after gastric bypass

Last Updated: 2017-09-29

By Marilynn Larkin

NEW YORK (Reuters Health) - People who undergo Roux-en-Y gastric bypass (RYGB) may experience anemia or other post-procedural adverse outcomes that may not be recognized during follow-up by non-bariatric specialists and could last 10 years or more, researchers in California say.

"Gastric bypass can be associated with a lifetime risk for malabsorption and deficiency of vitamins and minerals," Dr. Dan Eisenberg of Stanford University told Reuters Health.

"In our study of U.S. veterans undergoing (the procedure), we found high rates of anemia 10 years after surgery," he said by email. "However, rates of anemia were significantly lower in those individuals who were still (being) followed by a bariatric specialist more than five years after surgery."

Dr. Eisenberg and colleagues reviewed data from 2002 through 2006 for 74 patients (mean age, 51; 78% men) who underwent RYGB at a single Veterans Affairs Medical Center.

Mean body-mass index was 46.2 before the surgery and 33.7 at 10 years. The mean rate of preoperative anemia was 20%; it increased to 28% at one year post-RYGB, 31% at five years and 47% at 10 years, according to the report in JAMA Surgery, online September 20.

At 10 years, 22% of the patients were being followed by a bariatric specialist; 78% were not. The anemia rate increased nonsignificantly among the followed patients (from 13% preoperatively to 19% at 10 years). Those without bariatric specialist follow-up, by contrast, saw their anemia rate rise significantly, from 22% to 57%, during the same period.

Compared with those who had bariatric specialist follow-up, patients without such follow-up were significantly more likely (odds ratio, 6.1) to have anemia at 10 years after RYGB.

"Bariatric specialists have a particular understanding of the long-term risk for nutritional deficiency after gastric bypass, and have a low threshold to aggressively screen and treat vitamin and mineral deficiencies," Dr. Eisenberg observed.

"This highlights the importance of long-term follow-up of individuals who undergo gastric bypass," he stressed, "and the importance of effective communication between the bariatric team and the primary care providers who follow the patients routinely."

What about sleeve gastrectomy? Although the study did not include people who underwent that procedure, Dr. Eisenberg said, "we do not expect a similar long-term risk of anemia after sleeve gastrectomy, because the operation does not have a malabsorptive component."

Dr. Eric Sheu, a bariatric surgeon at Brigham and Women's Hospital in Boston, told Reuters Health by email, "The study is limited by the small number of patients and lack of a non-surgical control arm. Moreover, limited detail is provided on the underlying causes and treatments provided for anemia. Also, it is unclear how many patients had follow-up with a non-bariatric specialist, such as a primary care provider."

"Nevertheless, the study emphasizes the importance of life-long follow-up with a bariatric specialist after gastric bypass and other weight-loss operations," he observed. "Bariatric surgery is currently our most effective and durable treatment for obesity, diabetes, and other obesity-related medical problems, and the benefits of bariatric surgery have been shown to outweigh its risks."

"However," he continued, "bariatric specialist follow-up long after a patient has recovered from surgery and achieved weight loss is critical to avoiding long-term complications."

"As the authors note, further study to understand the barriers to bariatric follow-up care or to improve communication will be important, given the overall low rates of bariatric specialist follow-up nationally," he concluded.

SOURCE: http://bit.ly/2yJftel

JAMA Surg 2017.

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