{"title":"Post-bariatric surgery quality-of-life decline: analysis of the gut-brain axis.","authors":"Yuxuan Jiao, Shaohui Zhu, Huichao Xue, Yihao Wang, Yanfang Wang, Dong Hou","doi":"10.1007/s40519-025-01784-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Bariatric surgery has proven effective in enhancing metabolic health and achieving sustainable weight loss for individuals with obesity. However, some patients experience adverse psychological outcomes and reduced quality-of-life post-surgery, potentially linked to changes in the gut-brain axis. This review aims to synthesize current evidence on the interplay between bariatric surgery-induced gut-brain axis modifications and patients' psychological status.</p><p><strong>Methods: </strong>A systematic literature search was conducted across PubMed, Web of Science, and Embase, prioritizing clinical studies, mechanistic investigations, and meta-analyses. Inclusion criteria encompassed English-language articles examining psychological parameters, gut-derived hormones, and gut microbiota in adults after Roux-en-Y gastric bypass or sleeve gastrectomy.</p><p><strong>Results: </strong>Bariatric surgery fundamentally reprograms gut-brain communication through anatomical, endocrine, and neural plasticity mechanisms, a process associated with dual-edged metabolic benefits and neuropsychiatric risks. Mechanistic analyses suggest that postoperative dysregulation of GLP-1/PYY secretion, altered vagal afferent signaling, and sustained microbiota dysbiosis (reduced Bifidobacterium, elevated Proteobacteria) may represent potential correlates of these outcomes.</p><p><strong>Conclusions: </strong>Studies have demonstrated significant associations between mood, quality of life, psychological status, and gut-derived hormones or microbiota. A comprehensive understanding of how bariatric surgery impacts gut-brain signaling pathways is critical for optimizing long-term therapeutic outcomes and enhancing patient quality of life.</p><p><strong>Level of evidence: </strong>This manuscript is a Narrative Review. According to the grading criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM), this manuscript is categorized as Level III-IV evidence.</p>","PeriodicalId":11391,"journal":{"name":"Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity","volume":"30 1","pages":"73"},"PeriodicalIF":2.8000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405321/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40519-025-01784-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Bariatric surgery has proven effective in enhancing metabolic health and achieving sustainable weight loss for individuals with obesity. However, some patients experience adverse psychological outcomes and reduced quality-of-life post-surgery, potentially linked to changes in the gut-brain axis. This review aims to synthesize current evidence on the interplay between bariatric surgery-induced gut-brain axis modifications and patients' psychological status.
Methods: A systematic literature search was conducted across PubMed, Web of Science, and Embase, prioritizing clinical studies, mechanistic investigations, and meta-analyses. Inclusion criteria encompassed English-language articles examining psychological parameters, gut-derived hormones, and gut microbiota in adults after Roux-en-Y gastric bypass or sleeve gastrectomy.
Results: Bariatric surgery fundamentally reprograms gut-brain communication through anatomical, endocrine, and neural plasticity mechanisms, a process associated with dual-edged metabolic benefits and neuropsychiatric risks. Mechanistic analyses suggest that postoperative dysregulation of GLP-1/PYY secretion, altered vagal afferent signaling, and sustained microbiota dysbiosis (reduced Bifidobacterium, elevated Proteobacteria) may represent potential correlates of these outcomes.
Conclusions: Studies have demonstrated significant associations between mood, quality of life, psychological status, and gut-derived hormones or microbiota. A comprehensive understanding of how bariatric surgery impacts gut-brain signaling pathways is critical for optimizing long-term therapeutic outcomes and enhancing patient quality of life.
Level of evidence: This manuscript is a Narrative Review. According to the grading criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM), this manuscript is categorized as Level III-IV evidence.
目的：减肥手术已被证明在促进代谢健康和实现肥胖个体持续减肥方面是有效的。然而，一些患者会经历不良的心理结果和术后生活质量下降，这可能与肠-脑轴的变化有关。本综述旨在综合目前关于减肥手术诱导的肠-脑轴改变与患者心理状态之间相互作用的证据。方法：通过PubMed、Web of Science和Embase进行系统的文献检索，优先考虑临床研究、机制调查和荟萃分析。纳入标准包括检查成人Roux-en-Y胃旁路或袖式胃切除术后的心理参数、肠道源性激素和肠道微生物群的英文文章。结果：减肥手术从根本上通过解剖学、内分泌和神经可塑性机制重新编程肠脑通讯，这一过程具有双刃剑代谢益处和神经精神风险。机制分析表明，术后GLP-1/PYY分泌失调、迷走神经传入信号改变和持续的微生物群失调（双歧杆菌减少，变形杆菌升高）可能是这些结果的潜在相关因素。结论：研究表明情绪、生活质量、心理状态和肠道源性激素或微生物群之间存在显著关联。全面了解减肥手术如何影响肠-脑信号通路对于优化长期治疗结果和提高患者生活质量至关重要。证据水平：这篇手稿是一篇叙述性评论。根据牛津循证医学中心（Oxford Centre for evidence - Medicine， OCEBM）的分级标准，本文被归类为III-IV级证据。
期刊介绍：
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity is a scientific journal whose main purpose is to create an international forum devoted to the several sectors of eating disorders and obesity and the significant relations between them. The journal publishes basic research, clinical and theoretical articles on eating disorders and weight-related problems: anorexia nervosa, bulimia nervosa, subthreshold eating disorders, obesity, atypical patterns of eating behaviour and body weight regulation in clinical and non-clinical populations.
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