Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2632
Peer-review started: December 31, 2019
First decision: April 25, 2020
Revised: May 9, 2020
Accepted: May 16, 2020
Article in press: May 16, 2020
Published online: May 28, 2020
Obesity is increasing in industrialized countries. Among bariatric procedures for weight loss sleeve gastrectomy (SG) has emerged as an effective treatment of morbid obesity. The association between obesity and some psychopathological features, specifically binge eating disorder (BED) is frequent. Anhedonia was associated with uncontrolled, emotional and binge eating. Weight loss was greater in obese patients (Ob) without anhedonia. Ob with BED have a higher prevalence of postprandial distress syndrome (PDS), a subtype of functional dyspepsia (FD) according to Rome III criteria and, an increase of PDS has been described in Ob after SG.
The effect of specific patterns of eating behavior such as BED and on the development of FD symptoms has not yet been completely defined in Ob with and without SG. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.
In this study we aimed to assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.
Ob without SG, Ob with SG and healthy controls (HC) the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess anhedonia, the Beck Depression Inventory-II (BDI II) and state trait anxiety inventory (STAI) questionnaires to screen for depression and anxiety. They were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria.
Ob without SG who were positive for BED had a 4.7 higher risk of FD and a higher STAI-Y2 scores than Ob negative for BED, while SHAPS scores and BDI II did not differ between the two groups. Ob with SG showed a higher prevalence of PDS and STAI-Y1 and STAI-Y2 scores compared to Ob without SG. Conversely, Ob with SG had a lower prevalence of BED and BDI-II than Ob without SG. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B – 7. 099 (95%CI: -13.91- -0.29), P = 0.04].
Ob without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.
A more regular screening of PDS symptoms accordingly to Rome IV Criteria before bariatric surgery might help to disclose the presence of BED. An individual assessment of psychological factors such anhedonia should be incorporated into tailoring future treatment interventions in patients with unfavorable surgical outcome. Further research is urgently required to understand the pathophysiological interactions between anhedonia, BED and the onset of upper GI symptoms in morbidly obese patients pre and post bariatric surgery.