The Association between Anxiety and/or Depression Symptoms with Gastrointestinal Complaints Five Years after Metabolic and Bariatric Surgery - a Cross-sectional Study

Abstract Introduction Gastrointestinal (GI) symptoms are common following metabolic and bariatric surgery (MBS) and can significantly impair quality of life. Previous research indicates that anxiety and depressive symptoms could be associated with GI complaints. This study aims to investigate the association between anxiety and/or depressive symptoms and GI complaints five years after MBS. Methods In this cross-sectional study 220 participants who underwent MBS were included. Self-reported anxiety and/or depressive symptoms were measured with the Hospital Anxiety and Depression Scale and GI complaints with the Gastrointestinal Symptom Rating Scale . Differences in GI complaint scores between participants with no, mild or severe anxiety and/or depression symptoms were assessed using Kruskal-Wallis and post-hoc tests. Furthermore, the association between anxiety and/or depressive symptom categories and moderately-severe to severe GI complaints (any GRSR item score ≥ 5 out of 7) was assessed by modified Cox regression. Results Participants were on average 50 ± 11 years of age five years post-MBS, mostly female (81%) and predominantly underwent RYGB (87%). 28% reported anxiety and/or depressive symptoms, of which 15% mild and 13% severe. 42% of participants reported moderately-severe to severe GI complaints, of which 20% was severe. Participants with severe anxiety and/or depressive symptoms had significantly higher total and domain GI complaint scores (abdominal pain, reflux syndrome, constipation syndrome) than participants without these symptoms ( p <.001). Similar trends were found in participants with mild anxiety and/or depressive symptoms (total p <.001, reflux syndrome p =.048, constipation syndrome p =.005), the association with abdominal pain was on the borderline of significance ( p =.05). Participants with mild or severe anxiety and/or depressive symptoms respectively had a 1.75 (95%CI 0.98–3.11; not statistically significant) and 2.55 (95%CI 1.45–4.47) times higher risk (BMI and sleep adjusted prevalence ratio’s) of experiencing moderately-severe to severe GI complaints compared to those without. Conclusion Participants 5-years post-MBS with mild to severe self-reported anxiety and/or depressive symptoms are at a higher risk of reporting more severe GI complaints. These findings underscore the need to assess and refer anxiety and/or depressive symptoms when counselling patients after MBS with GI complaints.