1
|
Rieck JH, Heidinger H, Schlöricke E, Schmidt N, Krause S. Is Sigstad's score really capable of detecting post-surgical late dumping syndrome? Langenbecks Arch Surg 2024; 409:94. [PMID: 38472479 DOI: 10.1007/s00423-024-03283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND This clinical trial explores the Sigstad score for late dumping syndrome in postoperative patients who have undergone sleeve gastrectomy (SG) or One Anastomosis Gastric Bypass (OAGB). The aims of this study are to investigate the correlations with late dumping syndrome, to evaluate the reliability and validity of the Sigstad score and to discuss a modified scoring system. METHODS The study was conducted at the Obesity Center of the Westküstenklinikum Heide and included 271 patients. Data collection involved conducting interviews, diet diaries and measuring blood glucose levels. Non-parametric tests, logistic regression and McDonald's Omega were the selected statistical approaches. RESULTS Body Mass Index (BMI) decreased over time (-9.67 kg/m2 at 4 months, -15.58 kg/m2 at 12 months). Preoperatively, the Sigstad score exhibited the highest value, and no occurrences of late dumping syndrome were observed. No significant differences were found in BMI concerning late dumping syndrome or Sigstad score among postoperative patients. Postoperative patients experienced an increase in gastrointestinal symptoms. The reliability test showed a McDonald's omega value of 0.509. The analysis conducted through binary logistic regression indicated dizziness as a significant predictor of late dumping syndrome; however, this finding did not hold up after performing Bonferroni correction. CONCLUSION The Sigstad score is not a reliable or valid method for detecting late dumping syndrome after surgery for obesity and metabolic disorders. It is necessary to have alternatives that use objective measures and assess the quality of life, and that these alternatives be validated in large patient cohorts.
Collapse
Affiliation(s)
- Jan-Henrik Rieck
- Bariatric Surgery, Westküstenklinikum Heide, Esmarchstraße 50, 25746, Heide, Schleswig-Holstein, Germany.
| | - Hagen Heidinger
- Bariatric Surgery, Westküstenklinikum Heide, Esmarchstraße 50, 25746, Heide, Schleswig-Holstein, Germany
| | - Erik Schlöricke
- Bariatric Surgery, Westküstenklinikum Heide, Esmarchstraße 50, 25746, Heide, Schleswig-Holstein, Germany
| | - Nina Schmidt
- Bariatric Surgery, Westküstenklinikum Heide, Esmarchstraße 50, 25746, Heide, Schleswig-Holstein, Germany
| | - Steffen Krause
- Bariatric Surgery, Westküstenklinikum Heide, Esmarchstraße 50, 25746, Heide, Schleswig-Holstein, Germany
| |
Collapse
|
2
|
Müller A, Efeler S, Laskowski NM, Pommnitz M, Mall JW, Meyer G, Wunder R, Köhler H, Hüttl TP, de Zwaan M. Postoperative Dumping Syndrome, Health-Related Quality of Life, Anxiety, Depression, and Eating Disturbances: Results of a Longitudinal Obesity Surgery Study. Obes Facts 2024; 17:201-210. [PMID: 38320543 PMCID: PMC10987184 DOI: 10.1159/000536602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Given the lack of research on the relationship of post-surgery dumping syndrome and eating disturbances, the purpose of the present longitudinal study was to investigate whether dumping after obesity surgery is associated with pre-/postoperative eating disorder symptoms or addiction-like eating beyond the type of surgery, gender, health-realted quality of life (HRQoL) and anxiety/depressive symptoms. METHODS The study included 220 patients (76% women) before (t0) and 6 months after (t1) obesity surgery (sleeve gastrectomy [n = 152], Roux-en-Y gastric bypass [n = 53], omega loop gastric bypass [n = 15]). The Sigstad Dumping Score was used to assess post-surgery dumping syndrome. Participants further answered the Eating Disorder Examination Questionnaire (EDE-Q), Yale Food Addiction Scale 2.0 (YFAS 2.0), Short-Form Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) at t0 and t1. RESULTS The point prevalence of symptoms suggestive of post-surgery dumping syndrome was 33%. Regression analyses indicate an association of dumping with surgical procedure (bypass), female gender, reduced HRQoL, more anxiety/depressive symptoms, and potentially with binge eating but not with eating disorder symptoms in general or with addiction-like eating. CONCLUSION The current study failed to show a close relationship between the presence of self-reported dumping syndrome and eating disorder symptoms or addiction-like eating following obesity surgery. Further studies with longer follow-up periods should make use of clinical interviews to assess psychosocial variables and of objective measures to diagnose dumping in addition to standardized self-ratings.
Collapse
Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Salih Efeler
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Nora M. Laskowski
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Melanie Pommnitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Julian W. Mall
- Department of General, Visceral, Vascular, and Bariatric Surgery, Klinikum Nordstadt, Hanover, Germany
| | - Günther Meyer
- Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Graefeling, Germany
| | - Ruth Wunder
- Department of General, Visceral, and Bariatric Surgery, DRK-Krankenhaus Clementinenhaus, Hanover, Germany
| | - Hinrich Köhler
- Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Brunswick, Germany
| | - Thomas P. Hüttl
- Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Munich, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| |
Collapse
|
3
|
Migdanis A, Koukoulis GD, Chougias D, Migdanis I, Armeni E, Kanellakis S, Manouras A, Kapsoritakis A, Potamianos S. The Effect of Fat Supplementation on the Appearance of Symptoms Associated With Dumping Syndrome in Patients Having Undergone Gastric Surgery: Preliminary Results. Cureus 2023; 15:e48871. [PMID: 38106774 PMCID: PMC10724605 DOI: 10.7759/cureus.48871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND/OBJECTIVES Data on the effect of dietary fat on dumping syndrome (DS) symptoms are limited. The aim of this study was to assess the effect of the addition of fat to a carbohydrate meal on the appearance of DS symptoms and glycemic response, in patients who had undergone gastric surgery. SUBJECTS/METHODS This was an interventional crossover study. Patients scheduled for gastric surgical procedures related to DS at two surgical units of two public hospitals (General University Hospital of Larissa and General Hospital of Larissa) were considered for study inclusion. Patients presenting symptoms suggestive of diagnosis (n = 12), after the ingestion of a carbohydrate meal, were used as both intervention and control groups. During the intervention process, a fat supplement was added to the carbohydrate meal that was previously used for diagnosis. Glycemic response and the amount and intensity of DS symptoms provoked by the two meals were assessed at both appointments. RESULTS Blood glucose levels were significantly lower in the group that consumed the added fat meal compared with the group that consumed the carbohydrate meal 60 minutes after ingestion (p = 0.028). Furthermore, a significant reduction was noted in the amount of late dumping symptoms (p = 0.021) and the intensity of both early and late dumping symptoms (p = 0.007 and p = 0.012 respectively), after fat addition. Conclusions: Incorporating fat into a carbohydrate meal seems to attenuate postprandial blood glucose rises and reduce the amount and intensity of DS symptoms, in patients who had undergone gastric surgery.
Collapse
Affiliation(s)
- Athanasios Migdanis
- Faculty of Medicine, University of Thessaly, Larissa, GRC
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
| | | | - Dimitrios Chougias
- Department of Gastroenterology, General University Hospital of Larissa, Larissa, GRC
| | - Ioannis Migdanis
- Faculty of Medicine, University of Thessaly, Larissa, GRC
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, GRC
| | - Eleni Armeni
- Faculty of Medicine, University of Thessaly, Larissa, GRC
| | - Spyridon Kanellakis
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, GRC
| | | | - Andreas Kapsoritakis
- Department of Gastroenterology, General University Hospital of Larissa, Larissa, GRC
- Faculty of Medicine, University of Thessaly, Larissa, GRC
| | - Spyridon Potamianos
- Department of Gastroenterology, General University Hospital of Larissa, Larissa, GRC
- Faculty of Medicine, University of Thessaly, Larissa, GRC
| |
Collapse
|
4
|
Parzer V, Resl M, Stechemesser L, Wakolbinger M, Itariu B, Brix JM. [Postoperative management]. Wien Klin Wochenschr 2023; 135:729-742. [PMID: 37821696 PMCID: PMC10567962 DOI: 10.1007/s00508-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Bariatric surgery results in significant weight loss, reduction or even remission of obesity-associated comorbidities, reduced mortality, and improved quality of life in many patients; however, obesity is a chronic disease, thus follow-up care is required after bariatric surgery. Furthermore, specific issues, such as micronutrient deficiencies and subsequent complications, can arise both in the short-term and the long-term. Abdominal pain after bariatric surgery must always be regarded as a serious symptom. A further focus should be on the diagnosis and treatment of dumping syndrome. Patients with type 2 diabetes should be regularly screened for recurrent hyperglycemia as well as specific sequelae, even though blood glucose levels may be substantially improved or normalized. In addition to centers with multidisciplinary teams, primary care and, in particular, general practitioners will play an increasingly more important role in the follow-up care after bariatric surgery.
Collapse
Affiliation(s)
- Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Michael Resl
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Bianca Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| |
Collapse
|
5
|
D'hoedt A, Vanuytsel T. Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review. Acta Gastroenterol Belg 2023; 86:417-427. [PMID: 37814558 DOI: 10.51821/86.3.11476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. Methods A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Results Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Conclusion Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.
Collapse
Affiliation(s)
- A D'hoedt
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta) KULeuven, Leuven, Belgium
| |
Collapse
|
6
|
Mayer PK, Kao PY, Lee YC, Liao YF, Ho WC, Ben-Arie E. Acupuncture effect on dumping syndrome in esophagus cancer patients with feeding jejunostomy: A study protocol for a single blind randomized control trial. Medicine (Baltimore) 2023; 102:e33895. [PMID: 37335662 DOI: 10.1097/md.0000000000033895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Esophagus cancer patients are at risk for malnourishment. Feeding jejunostomy is used in advanced esophagus cancer patients in order to support and supplement the patients' nutrition needs. In dumping syndrome, the food is rapidly introduced into the intestine at a rate that is faster than normal, it is associated with both digestive system and vasoactive symptoms. Dumping syndrome has an association with both esophagus cancer patients and feeding jejunostomy. In the mid and long term, dumping syndrome is an important issue that contributes to the risk of malnourishment in advanced esophagus cancer patients. In recent studies, acupuncture was effective in regulating digestive symptoms. Acupuncture is considered to be a safe intervention, that was previously shown to be effective in treating digestive-related symptoms. METHODS Sixty advanced esophageal cancer patients post-feeding jejunostomy will be divided into 2 equal groups, an intervention group (n = 30) and a control group (n = 30). Patients in the intervention group will receive acupuncture using the following acupoints: ST36 (Zusanli), ST37 (Shangjuxu), ST39 (Xiajuxu), PC6 (Neiguan), LI4 (Hegu), and Liv 3 (Taichung). Patients in the control group will receive shallow acupuncture on 12 non-acupoints (sham points), 1 cm from the above mention points. Patients and assessors will be blind to trial allocation. Both groups will receive acupuncture twice a week for 6 weeks. The main outcome measurements are: body weight, BMI, Sigstad's score, and the Arts' dumping questionnaire. DISCUSSION There are no previous studies that have examined the use of acupuncture on patients with dumping syndrome. This single-blind randomized control trial will investigate the effect of acupuncture on dumping syndrome in advanced esophagus cancer patients with feeding jejunostomy. The results will determine if verum acupuncture can affect dumping syndrome and prevent weight loss.
Collapse
Affiliation(s)
- Peter Karl Mayer
- International Master Program in Acupuncture, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Yu Kao
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Surgical Intensive Care Unit, China Medical University Hospital, Taichung, Taiwan
- Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chen Lee
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yi-Fang Liao
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Eyal Ben-Arie
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Pereira SE, Rossoni C, Cambi MPC, Faria SL, Mattos FCC, De Campos TBF, Petry TBZ, Da Silva SA, Pereira AZ, Umeda LM, Nogueira C, De Araújo Burgos MGP, Magro DO. Brazilian guide to nutrition in bariatric and metabolic surgery. Langenbecks Arch Surg 2023; 408:143. [PMID: 37039877 DOI: 10.1007/s00423-023-02868-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.
Collapse
Affiliation(s)
- Silvia Elaine Pereira
- Postgraduate Program in Nutritional Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Carina Rossoni
- Faculty of Medicine (ISAMB), Instituto of Environmental Health, Universidade de Lisboa, Lisbon, Portugal.
| | | | - Silvia Leite Faria
- Postgraduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | | | | | | | - Silvia Alves Da Silva
- Postgraduate Program in Nutritional in Bariatric Surgery, Federal University of Pernambuco, Recife, Brazil
| | | | - Luciana Mela Umeda
- Medical Residency Program in Endrocrinology and Metabology, Ipiranga Hospital, São Paulo, Brazil
| | - Carla Nogueira
- Postgraduate Program in Human Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | |
Collapse
|
8
|
Weiss J, Fewel C, Akinrinade O, Harrington J. Late dumping syndrome preceded by Coxsackievirus B4 infection and cholecystectomy. J Surg Case Rep 2023; 2023:rjad205. [PMID: 37124576 PMCID: PMC10131098 DOI: 10.1093/jscr/rjad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/25/2023] [Indexed: 05/02/2023] Open
Abstract
A 44-year-old female patient presented with weight loss, diarrhea and intermittent episodes of left upper quadrant (LUQ) pain lasting for 3 years, accompanied by acute episodes of focal LUQ pain, dizziness, tachycardia, borborygmi and bloating, occurring approximately 60 min after meals. The patient developed chronic acalculous cholecystitis and transient exocrine pancreatic insufficiency after infection with Coxsackievirus B4 (CVB4), which resolved following laparoscopic cholecystectomy 2 years before the current presentation. Although imaging and functional investigation studies were unremarkable, a gastric transit study revealed rapid clearance of radiolabeled food, and the patient's symptomatology and gastrointestinal studies supported the diagnosis of late dumping syndrome. The patient's symptoms significantly improved with adherence to recommended dietary changes, including an increase in protein intake, abstinence from simple carbohydrates and avoidance of simultaneous consumption of beverages with food, following consultation with a dietitian.
Collapse
Affiliation(s)
- Joshua Weiss
- Department of Microbiology, St. George’s University, School of Medicine, True Blue Campus, St. George, Grenada, West Indies
| | - Connor Fewel
- Department of Microbiology, St. George’s University, School of Medicine, True Blue Campus, St. George, Grenada, West Indies
| | - Oyediran Akinrinade
- Department of Microbiology, St. George’s University, School of Medicine, True Blue Campus, St. George, Grenada, West Indies
| | - Jane Harrington
- Correspondence address. St. George’s University, School of Medicine, St. George, Grenada, West Indies. Tel: +1-473-444-4175, ext. 3034; E-mail:
| |
Collapse
|
9
|
Transoral Outlet Reduction (TORe) for the Treatment of Weight Regain and Dumping Syndrome after Roux-en-Y Gastric Bypass. Medicina (B Aires) 2023; 59:medicina59010125. [PMID: 36676749 PMCID: PMC9865659 DOI: 10.3390/medicina59010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
Obesity is a chronic relapsing disease of global pandemic proportions. In this context, an increasing number of patients are undergoing bariatric surgery, which is considered the most effective weight loss treatment for long-term improvement in obesity-related comorbidities. One of the most popular bariatric surgeries is the Roux-en-Y gastric bypass (RYGB). Despite its proven short- and long-term efficacy, progressive weight regain and dumping symptoms remain a challenge. Revisional bariatric surgery is indicated when dietary and lifestyle modification, pharmaceutical agents and/or psychological therapy fail to arrest weight regain or control dumping. However, these re-interventions present greater technical difficulty and are accompanied by an increased risk of peri- and postoperative complications with substantial morbidity and mortality. The endoscopic approach to gastrojejunal anastomotic revision, transoral outlet reduction (TORe), is used as a minimally invasive treatment that aims to reduce the diameter of the gastrojejunal anastomosis, delaying gastric emptying and increasing satiety. With substantial published data supporting its use, TORe is an effective and safe bariatric endoscopic technique for addressing weight regain and dumping syndrome after RYGB.
Collapse
|
10
|
Kermansaravi M, ShahabiShahmiri S, Vilallonga R, Gholizadeh B, DavarpanahJazi AH, Farsi Y, Valizadeh R, Rezvani M. Severity of post-Roux-en-Y gastric bypass dumping syndrome and weight loss outcomes: is there any correlation? Langenbecks Arch Surg 2023; 408:10. [PMID: 36607445 PMCID: PMC9823071 DOI: 10.1007/s00423-022-02736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The present research was conducted to evaluate the effect of the severity of dumping syndrome (DS) on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) in patients with class III obesity. METHODS The present retrospective cohort study used the dumping symptom rating scale (DSRS) to evaluate the severity of DS and its correlation with weight loss outcomes in 207 patients 1 year after their RYGB. The patients were assigned to group A with mild-to-moderate DS or group B with severe DS. RESULTS The mean age of the patients was 42.18 ± 10.46 years and their mean preoperative BMI 42.74 ± 5.59 kg/m2. The total weight loss percentage (%TWL) in group B was insignificantly higher than that in group A, but besides that was not significantly different in the two groups. CONCLUSION The present findings suggested insignificant relationships between the presence and severity of DS after RYGB and adequate postoperative weight loss.
Collapse
Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab ShahabiShahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Ramon Vilallonga
- Obesity and Metabolic Surgery Unit, Vall Hebron Campus Hospital, Barcelona, Spain.
| | - Barmak Gholizadeh
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hossein DavarpanahJazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Farsi
- Department of General Surgery, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rohollah Valizadeh
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Urmia University of Medical Sciences, Urmia, Iran
| | - Masoud Rezvani
- Department of Surgery, Davis Hwy, Inova Fair Oaks Hospital, 14904 JeffersonSuite 205, Woodbridge, VA, USA
| |
Collapse
|
11
|
Muacevic A, Adler JR, Alghamdi T, Saud F, Binyamin S, Alghamdi Y, Al-Raddadi R. Prevalence of Dumping Syndrome and Its Determinants Among Post-Bariatric Surgery Adult Patients at King Fahad General Hospital, Jeddah, 2019-2020. Cureus 2022; 14:e32630. [PMID: 36654626 PMCID: PMC9841919 DOI: 10.7759/cureus.32630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Bariatric surgery is one of the most effective interventions for morbid obesity. Despite its benefits, unwanted consequences such as dumping syndrome (DS) have been reported following the procedure. This study aims to estimate the prevalence of DS and identify the factors associated with it in Saudi Arabia. Methodology This cross-sectional study collected data from patients who underwent bariatric surgery at King Fahad General Hospital, Jeddah, Saudi Arabia, in 2019-2020. A validated questionnaire was used to collect the data. The questionnaire included demographic items such as age and sex and items relating to DS such as nausea, vomiting, and palpitations. A modified version of the Sigstad diagnostic scoring system was used to confirm the diagnosis. Results Of the 240 investigated cases, two-thirds (67.5%) were females. The most reported symptoms were nausea (37.9%), vomiting (36.7%), desire to lie down (25.5%), restlessness (25.5%), and abdominal fullness (23.7%). Based on the modified Sigstad diagnostic scoring system, 75 (31.4%) patients met the criteria for DS. The bivariate analysis showed the prevalence was significantly higher in females (36.4%), those with university qualifications (40.3%), and those with high monthly income (62.5%) (p<0.05). Also, dietary behaviors in terms of frequency, size of meals, and drinking liquids with meals were significantly associated with the prevalence of DS, where the lowest prevalence was recorded among those who ate more than one small meal (10.9%), while the highest prevalence was found in those who ate more than one large meal (81.8%); also, the prevalence was significantly higher in patients who drank liquids with meals (40.8%) than those who drank liquids between meals (26.8%) (p<0.05). Conclusion In this single institutional study, we report a 31.4% prevalence of DS among our cohort. The predictors of the syndrome include gender, education level, monthly income, eating more than one large meal per day, and drinking liquids with meals. In the future, these predictors will be explained to patients before and after bariatric surgery to reduce the prevalence of such inconvenient syndromes.
Collapse
|
12
|
Hong YR, Yadav S, Suk R, Lee AM, Newsome FA, Johnson-Mann CN, Cardel MI, Ross KM. Assessment of Physical Activity and Healthy Eating Behaviors Among US Adults Receiving Bariatric Surgery. JAMA Netw Open 2022; 5:e2217380. [PMID: 35708688 PMCID: PMC9204540 DOI: 10.1001/jamanetworkopen.2022.17380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IMPORTANCE Bariatric surgery effectively treats severe obesity and metabolic diseases. However, individual outcomes vary depending on sustainable lifestyle change. Little is known about lifestyle patterns after bariatric surgery among the US population. OBJECTIVE To compare the level of physical activity and eating behavior among postbariatric surgery patients, individuals eligible for surgery, and those with normal weight. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study using nationally representative survey data from National Health and Nutrition Examination Survey 2015-2018. Respondents included for analysis were age 18 years or older, and categorized by individuals with normal weight, individuals who received bariatric surgery, and individuals clinically eligible for bariatric surgery. Analyses were performed from February to October 2021. MAIN OUTCOMES AND MEASURES Self-reported measures were used to assess physical activity (moderate-to-vigorous physical activity [MVPA], sedentary activity, and whether PA guidelines were met) and eating behaviors (total energy intake and Healthy Eating Index [HEI]-2015 diet quality scores). RESULTS Of 4659 study participants (mean [SD] age, 46.1 [18.6] years; 2638 [weighted percentage, 58.8%] women; 1114 [weighted percentage, 12.7%] Black, 1570 [weighted percentage, 68.6%] White), 132 (3.7%) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was 7 (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in MVPA than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (95% CI, 40.8% to 52.4%) reported meeting PA guidelines, almost 2 times higher than those in the bariatric surgery (23.1%; 95% CI, 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 95% CI, 15.6% to 25.1%). Propensity-score weighted overall HEI was higher for individuals with normal weight (54.4; 95% CI, 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 95% CI, 47.2 to 52.9) or were eligible for the surgery (48.0; 95% CI, 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d). CONCLUSIONS AND RELEVANCE In this cross-sectional study, individuals who underwent bariatric surgery had beneficial lifestyle patterns compared with those eligible for surgery; however, these improvements seemed suboptimal based on the current guidelines. Efforts are needed to incorporate benefits of physical activity and a healthy, balanced diet in postbariatric care.
Collapse
Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida, Gainesville
- University of Florida Health Cancer Center, Gainesville
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida, Gainesville
| | - Ryan Suk
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Alexandra M. Lee
- Department of Kinesiology, Pennsylvania State University, University Park
| | - Faith A. Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
| | | | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
- WW International, Inc, New York, New York
| | - Kathryn M. Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions University of Florida, Gainesville
| |
Collapse
|
13
|
Nymo S, Lundanes J, Aukan M, Sandvik J, Johnsen G, Græslie H, Larsson I, Martins C. Diet and physical activity are associated with suboptimal weight loss and weight regain 10-15 years after Roux-en-Y gastric bypass: A cross-sectional study. Obes Res Clin Pract 2022; 16:163-169. [PMID: 35393266 DOI: 10.1016/j.orcp.2022.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/17/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Suboptimal weight loss (SWL) after bariatric surgery affects approximately 30% of the patients in the long-term. Diet and physical activity (PA) are likely to modulate long term weight loss outcomes after Roux-en-Y gastric bypass (RYGB). OBJECTIVES To compare food habits and PA levels between those experiencing SWL and optimal weight loss (OWL), and between those experiencing weight regain (WR) and no weight regain (NWR), 10-15 years after RYGB, in addition to a pre-operative control group. METHODS Participants were recruited from the Bariatric Surgery Observation Study (BAROBS), ≥ 10 y after RYGB. Food intake was assessed by a Food Frequency Questionnaire (FFQ) and PA levels with Sensewear armbands. RESULTS 75 participants (79% females) were recruited. Excess weight loss (EWL) was 17 ± 19% and 87 ± 22% in the SWL and OWL groups, respectively and WR was 31 ± 15% and 1 ± 11% in the WR and NWR groups, respectively (P < 0.001 for both). The OWL group reported a lower energy intake (P = 0.012) than the control group. The control group reported a higher intake of milk, cream and cheese than both SWL group (P = 0.008) and OWL group (P < 0.001). The SWL group reported a higher intake of processed meat products than the OWL group, while the OWL group reported a lower intake of sauces than both the SWL and the control groups (P < 0.001 and P = 0.005, respectively). The OWL group reported a lower intake of cakes, sugar and sweets than both SWL group (P = 0.035) and control group (P = 0.021). The WR group reported a lower PA duration (P = 0.046) compared with the NWR group. EWL was positively, and WR negatively, correlated with average PA duration. CONCLUSION A high intake of energy-dense foods and low PA is associated with poor weight loss outcomes, namely SWL and WR, 10-15 years after RYGB.
Collapse
Affiliation(s)
- Siren Nymo
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Nord-Trøndelag Hospital Trust, Clinic of Surgery, Namsos Hospital, Norway; Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway.
| | - Julianne Lundanes
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Nord-Trøndelag Hospital Trust, Clinic of Surgery, Namsos Hospital, Norway
| | - Marthe Aukan
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jorunn Sandvik
- Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway; More-Romsdal Hospital Trust, Department of Medicine, Ålesund Hospital, Norway
| | - Gjermund Johnsen
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Hallvard Græslie
- Nord-Trøndelag Hospital Trust, Clinic of Surgery, Namsos Hospital, Norway
| | - Ingrid Larsson
- Regional Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catia Martins
- Obesity Research Group, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Centre for Obesity and Innovation (ObeCe), Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway; Department of Nutrition Sciences, University of Alabama at Birmingham, AL, USA
| |
Collapse
|
14
|
Choi SI. Is the Sleeve Gastrectomy Sufficient or Does it Require Additional Surgical Procedures? JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:9-13. [PMID: 36687753 PMCID: PMC9847646 DOI: 10.17476/jmbs.2021.10.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 06/17/2023]
Abstract
Laparoscopic sleeve gastrectomy is a relatively simple procedure and has become the most well-known bariatric surgical procedure in Korea and Western countries. However, this procedure has several disadvantages in terms of long-term weight loss and metabolic disease control. Laparoscopic sleeve gastrectomy and additional bypass (sleeve plus) procedures were recently introduced into bariatric surgery in order to combine the physiologic advantages of pyloric-saving reconstruction and the bypass effect. A sleeve gastrectomy was performed first, followed by a bypass procedure. This review describes sleeve plus procedures reported in the literature and compares their outcomes with the most frequently performed techniques.
Collapse
Affiliation(s)
- Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| |
Collapse
|
15
|
Rebelos E, Moriconi D, Scalese M, Denoth F, Molinaro S, Siciliano V, Anselmino M, Taddei S, Ferrannini E, Nannipieri M. Impact of Postprandial Hypoglycemia on Weight Loss After Bariatric Surgery. Obes Surg 2021; 30:2266-2273. [PMID: 32133587 DOI: 10.1007/s11695-020-04465-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Postprandial hypoglycemia (PPHG) is a well-known complication after bariatric surgery (BS). However, it is not known whether PPHG affects weight loss after BS. AIMS To assess the impact of PPHG on weight loss after BS in subjects without and with type 2 diabetes mellitus (T2D). METHODS Data from 338 subjects who had undergone gastric bypass (RYGB) or sleeve gastrectomy (LSG) and were followed up for at least 2 years were analyzed. At each follow-up visit, the patient's anthropometric and biochemical characteristics were recorded and the Edinburgh Questionnaire was performed to evaluate the presence of PPHG symptoms. RESULTS Before surgery: younger age and lower BMI predicted PPHG after BS (p = 0.02 and p = 0.0008, respectively). Also, the baseline OGTT indicated that subjects who developed PPHG had an earlier glucose peak and more often had low glucose levels at 2 h compared with the no-PPHG group (p = 0.03 and p = 0.004, respectively). After surgery: Mild-to-moderate PPHG occurred equally after RYGB and LSG (38% vs 25%, p = ns when accounting for confounders), and in T2D who achieved remission and those who did not (29.5% vs 28.6%, ns). At the 2-year follow-up, occurrence of PPHG was independently associated with smaller weight loss (p = 0.0006). CONCLUSIONS Mild-to-moderate PPHG is a frequent complication after bariatric surgery and results in smaller weight loss after 2 years. Age, baseline BMI, and an earlier glucose peak during OGTT predict PPHG after bariatric surgery.
Collapse
Affiliation(s)
- Eleni Rebelos
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | | | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
16
|
Lupher V, Lynch A, Zalesin KC. Health, Weight Loss, and Surgery Beliefs: Why Patients Choose to Undergo Bariatric Surgery and What Influences Their Choice of Surgery Procedure. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victoria Lupher
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Amanda Lynch
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Kerstyn C. Zalesin
- Weight Control Center, William Beaumont Hospital, Royal Oak, Michigan, USA
| |
Collapse
|
17
|
Scarpellini E, Arts J, Karamanolis G, Laurenius A, Siquini W, Suzuki H, Ukleja A, Van Beek A, Vanuytsel T, Bor S, Ceppa E, Di Lorenzo C, Emous M, Hammer H, Hellström P, Laville M, Lundell L, Masclee A, Ritz P, Tack J. International consensus on the diagnosis and management of dumping syndrome. Nat Rev Endocrinol 2020; 16:448-466. [PMID: 32457534 PMCID: PMC7351708 DOI: 10.1038/s41574-020-0357-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international multidisciplinary experts. We defined the scope, proposed statements and searched electronic databases to survey the literature. Eighteen experts participated in the literature summary and voting process evaluating 62 statements. We evaluated the quality of evidence using grading of recommendations assessment, development and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 33 of 62 statements, including the definition and symptom profile of dumping syndrome and its effect on quality of life. The panel agreed on the pathophysiological relevance of rapid passage of nutrients to the small bowel, on the role of decreased gastric volume capacity and release of glucagon-like peptide 1. Symptom recognition is crucial, and the modified oral glucose tolerance test, but not gastric emptying testing, is useful for diagnosis. An increase in haematocrit >3% or in pulse rate >10 bpm 30 min after the start of the glucose intake are diagnostic of early dumping syndrome, and a nadir hypoglycaemia level <50 mg/dl is diagnostic of late dumping syndrome. Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose.
Collapse
Affiliation(s)
- Emidio Scarpellini
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing (ChroMetA), Catholic University of Leuven, Leuven, Belgium
| | - Joris Arts
- Gastroenterology Division, St Lucas Hospital, Bruges, Belgium
| | - George Karamanolis
- 2nd Department of Internal Medicine - Propaedeutic, Hepatogastroenterology Unit, Attikon University Hospital, Medical School, Athens University, Athens, Greece
| | - Anna Laurenius
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Walter Siquini
- Politechnic University of Marche, "Madonna del Soccorso" General Hospital, San Benedetto del Tronto, Italy
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Andrew Ukleja
- Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andre Van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing (ChroMetA), Catholic University of Leuven, Leuven, Belgium
| | - Serhat Bor
- Division of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marloes Emous
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Heinz Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Per Hellström
- Department of Medical Sciences, Gastroenterology/Hepatology, Uppsala University, Uppsala, Sweden
| | - Martine Laville
- Department of Endocrinology, Claude Bernard University, Lyon, France
| | - Lars Lundell
- Department of Surgery Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Ad Masclee
- Department of Gastroenterology-Hepatology, University Hospital Leiden, Leiden, Netherlands
| | | | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing (ChroMetA), Catholic University of Leuven, Leuven, Belgium.
| |
Collapse
|
18
|
Vargas EJ, Abu Dayyeh BK, Storm AC, Bazerbachi F, Matar R, Vella A, Kellogg T, Stier C. Endoscopic management of dumping syndrome after Roux-en-Y gastric bypass: a large international series and proposed management strategy. Gastrointest Endosc 2020; 92:91-96. [PMID: 32112780 DOI: 10.1016/j.gie.2020.02.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Roux-en-Y gastric bypass (RYGB) is refractory to lifestyle and pharmacotherapy measures, requiring reversal of the patient's bariatric surgery. Reversal can lead to weight regain and recrudescence of their comorbidities. Our aim was to report a multicenter experience on the endoscopic management of refractory dumping syndrome with endoscopic transoral outlet reduction (TORe). METHODS A multicenter international series of consecutive patients who underwent TORe with a full-thickness endoscopic suturing device was analyzed for technical success, improvement in Sigstad scores, and weight trajectories after the procedure. Failure was defined as needing an enteral feeding tube, surgical reversal, or repeat TORe. RESULTS One hundred fifteen patients across 2 large academic centers in Germany and the United States underwent TORe for dumping syndrome. Patient age was mean 8.9 ± 1.1 years from their initial RYGB with an average percent total body weight loss of 31% ± 10.6% at the time of endoscopy. Three months postprocedure, the Sigstad score improved from a mean of 17 ± 6.1 to 2.6 ± 1.9 (paired t test P = .0001) with only 2% of patients (n = 2) experiencing weight gain. Mean weight loss and percentage of total body weight loss 3 months post-TORe were 9.47 ± 3.6 kg and 9.47% ± 2.5%, respectively. Six patients (5%) failed initial endoscopic therapy, with 50% (n = 3) successfully treated with a repeat TORe. Three patients underwent surgical reversal, indicating an overall 97% endoscopic success rate. CONCLUSIONS TORe as an adjunct to lifestyle and pharmacologic therapy for refractory dumping syndrome is safe and effective at improving dumping syndrome and reducing rates of surgical revision.
Collapse
Affiliation(s)
- Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology, Interventional Endoscopy Program, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd Kellogg
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine Stier
- Department of Endocrinology, University Hospital, Würzburg, Germany
| |
Collapse
|
19
|
Park JH, Park YE, Kang MR. [Post-meningitis Dumping Syndrome: A Case Report and Literature Review]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 75:347-350. [PMID: 32581206 DOI: 10.4166/kjg.2020.75.6.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/03/2022]
Abstract
Dumping syndrome has long been associated with gastric surgery. The authors experienced an adult patient presenting with dumping syndrome after meningitis without any previous surgical procedures on the stomach and small bowel. Dysfunction of the autonomic nervous system after infective meningitis may originate from postinfectious sequelae or an immunologic mechanism. A comprehensive study and proper management of autonomic symptoms of patients with a central nervous system infection are needed.
Collapse
Affiliation(s)
- Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Mi-Ri Kang
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
20
|
Ahmad A, Kornrich DB, Krasner H, Eckardt S, Ahmad Z, Braslow A, Broggelwirth B. Prevalence of Dumping Syndrome After Laparoscopic Sleeve Gastrectomy and Comparison with Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:1506-1513. [PMID: 30635813 DOI: 10.1007/s11695-018-03699-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dumping syndrome is a well-known side effect of laparoscopic gastric bypass (LRYGB), and it is commonly believed that dumping syndrome is less likely to occur after laparoscopic sleeve gastrectomy (LSG), due to the preservation of the pyloric sphincter. However, it is not uncommon for patients undergoing LSG at our center to report symptoms suggestive of dumping syndrome. OBJECTIVE To assess the prevalence of symptoms of dumping syndrome after LSG compared with LRYGB. SETTING A single surgical group at a high-volume (700 cases per year) Bariatric and Metabolic Surgery Center of Excellence. METHODS One thousand four hundred seventy-one LRYGB (366) and LSG (1105) patients received a questionnaire to assess symptoms of dumping syndrome, utilizing a modified version of the Sigstad scoring system. Dumping syndrome was considered to be present when the questionnaire score exceeded a threshold value. RESULTS A total of 360 responses were received (249 LSG, 111 LRYGB). 26.5% (66) LSG and 41.4% (46) LRYGB exceeded the threshold for dumping syndrome (p < 0.01). 84.8% (56) LSG and 84.7% (39) LRYGB reported early dumping syndrome (p > 0.05). Thirty-six percent (24) LSG and 28% (13) LRYGB reported late dumping syndrome (p > 0.05). Twenty-seven percent (62) LSG and 44.4% (44) LRYGB reported at least one symptom of dumping syndrome with sweets (p < 0.05). 34.3% (85) LSG and 35.5% (39) LRYGB reported symptoms when drinking with or within 30 min of a meal (p > 0.05). 14.5% (36) LSG and 17.3% (19) LRYGB reported symptoms after alcohol consumption (p > 0.05). CONCLUSION Dumping syndrome after LSG is prevalent but has not been widely reported. This finding may impact clinicians and patients in their choice of procedure and has relevance in post-operative education and care.
Collapse
Affiliation(s)
- Arif Ahmad
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA.
| | | | - Helaine Krasner
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Sarah Eckardt
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Zoha Ahmad
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - AnnaMarie Braslow
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Barbara Broggelwirth
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| |
Collapse
|
21
|
Hong S, Park B, Noh H, Choi DJ. Herbal Medicine for Dumping Syndrome: A Systematic Review and Meta-Analysis. Integr Cancer Ther 2019; 18:1534735419873404. [PMID: 31549529 PMCID: PMC6759702 DOI: 10.1177/1534735419873404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Dumping syndrome is a common complication of surgical treatment of gastric cancer, but conventional therapy has limitations related to symptom care due to its structural cause and the decreased quality of life. Objectives: The objective of this review was to assess the clinical evidence for the effectiveness of herbal medicine as a treatment for dumping syndrome. Methods: A literature review was conducted using 16 databases from their inceptions to March 2018. All randomized controlled trials (RCTs) of herbal medicine used to treat dumping syndrome patients were included and meta-analyzed. Methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 174 dumping syndrome patients of 3 trials met all inclusion criteria. Two trials assessed the effectiveness of herbal medicine on the symptom response rate compared with conventional pharmacotherapy. Their results suggested significant effects in favor of herbal medicine (risk ratio [RR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, P = .0003, heterogeneity τ2 = 0, χ2 = 0.02, P = .88, I2 = 0%). One trial assessed its effectiveness on the improvement rate of overall symptoms compared with conventional conservative complex therapy, such as postural management, diet regulation, and counseling (RR = 1.23, 95% CI = 0.96-1.58). Conclusions: Due to the small sample size, scarcity of reported articles, and lack of quality of the current RCTs, it was concluded that the effectiveness of herbal medicine in treating dumping syndrome is unclear.
Collapse
Affiliation(s)
- Seungcheol Hong
- Dongguk University, Seoul, Republic of Korea.,Ilsan Oriental Hospital, Dongguk University Medical Centre, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Bongki Park
- Mirae Korean Medicine Clinic, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | | | - Dong-Jun Choi
- Dongguk University, Seoul, Republic of Korea.,Ilsan Oriental Hospital, Dongguk University Medical Centre, Goyang-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
22
|
Asarian L, Geary N. RYGB and flavor-consequence learning. Appetite 2019; 146:104467. [PMID: 31557496 DOI: 10.1016/j.appet.2019.104467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
Flavor-consequence learning refers to learned associations between flavor stimuli and post-oral consequences of food that affect food selection, amount eaten and affect. Forms of flavor-consequence learning include flavor aversions, flavor avoidance, conditioned satiety, expected satiety and appetition. Roux-en-Y gastric bypass surgery (RYGB) and other bariatric procedures alter gastrointestinal processing of food in a number of ways. Thus, it is plausible that these procedures alter post-oral unconditioned stimuli that support flavor-consequence learning, leading to altered food selection, amount eaten, and affect. Surprisingly, however, there is almost no research on the role of flavor-consequence learning in the effects of bariatric surgery on appetite. This issue urgently warrants investigation.
Collapse
Affiliation(s)
- Lori Asarian
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, 05405, USA.
| | - Nori Geary
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, 10025, USA
| |
Collapse
|
23
|
Vavricka SR, Greuter T. Gastroparesis and Dumping Syndrome: Current Concepts and Management. J Clin Med 2019; 8:jcm8081127. [PMID: 31362413 PMCID: PMC6723467 DOI: 10.3390/jcm8081127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. Although gastroparesis results from delayed gastric emptying and dumping syndrome from accelerated emptying of the stomach, the two entities share several similarities among which are an underestimated prevalence, considerable impairment of quality of life, the need for a multidisciplinary team setting, and a step-up treatment approach. In the following review, we will present an overview of the most important clinical aspects of gastroparesis and dumping syndrome including epidemiology, pathophysiology, presentation, and diagnostics. Finally, we highlight promising therapeutic options that might be available in the future.
Collapse
Affiliation(s)
- Stephan R Vavricka
- Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland.
- Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
| |
Collapse
|
24
|
Neuberg M, Wuidar PA, Kohnen L, Deflines J, Kotzampassakis N, Demarche M, De Roover A. Laparoscopic Magenstrasse and Mill Gastroplasty (M&M): Midterm Results. Obes Surg 2019; 29:3212-3219. [PMID: 31254215 DOI: 10.1007/s11695-019-03965-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Magenstrasse and Mill gastroplasty (M&M) is a gastric restrictive procedure without band or stomach resection. Short-term evaluation of the laparoscopic procedure showed low morbidity and satisfactory results on weight loss. Evidence of the validity of the technique in the longer term is scarce. METHODS Data from patients who underwent M&M procedure from May 2012 to September 2015 were retrospectively reviewed. Preoperative clinical characteristics and data up to 4 years after operation were analyzed. RESULTS A total of 132 patients were included in this study with a mean age of 46 ± 13.4 years. The mean body mass index (BMI) at the time of procedure was 43 ± 4.5 kg/m2. Mean percentage of excess weight loss (%EWL) was 67, 67, 58, and 57% at 1, 2, 3, and 4 years, respectively. The remission rate for diabetes was 36%. About half of the insulin-dependent patients could stop their insulin treatment. Hypertension was resolved in 33.8% of the patients after 4 years. Incidence of vitamin and mineral deficiency was low throughout the study period, less than or equal to 3% for vitamin B12 and 1% for ferritin. Incidence of gastroesophageal reflux did not exceed 15% during the study. Over 75% of the patients reported a good or very good quality of life following the surgery. CONCLUSION These results confirm the validity of M&M as a bariatric procedure. The low incidence of vitamin deficiencies and gastroesophageal reflux might be the important asset of M&M over other existing techniques.
Collapse
Affiliation(s)
- Maud Neuberg
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
| | - Pierre-Arnaud Wuidar
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laurent Kohnen
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Jenny Deflines
- Department of Diabetology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Nikos Kotzampassakis
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Martine Demarche
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Arnaud De Roover
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| |
Collapse
|
25
|
Wiedemann AA, Ivezaj V, Grilo C. An examination of emotional and loss-of-control eating after sleeve gastrectomy surgery. Eat Behav 2018; 31:48-52. [PMID: 30118925 PMCID: PMC6247803 DOI: 10.1016/j.eatbeh.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 01/21/2023]
Abstract
Emotional eating has been identified as a predictor of poorer weight loss outcomes in non-bariatric clinical samples. It is unknown, however, whether emotional eating contributes to poorer weight loss outcomes after bariatric surgery or how it might be associated with loss-of-control (LOC) eating, a known predictor of post-surgical outcomes. This study examined the nature and significance of emotional eating among post-bariatric surgery patients with LOC eating. Participants (N = 134) were patients with LOC eating (at least once weekly) seeking treatment to help improve eating approximately 4-9 months following sleeve gastrectomy surgery. Participants were assessed with the Eating Disorder Examination-Bariatric Surgery Version interview, Yale Emotional Overeating Questionnaire, and Beck Depression Inventory-II. Emotional eating and LOC eating were significantly negatively correlated with post-surgical weight loss (p's < 0.05), both variables had a small effect. Linear regression analyses revealed that both emotional eating and frequency of LOC eating were independently associated with weight loss (R2 = 0.041 and 0.049, respectively). Our findings suggest that, among post-sleeve gastrectomy patients with LOC eating, greater frequency of LOC eating and LOC eating in response to emotions are associated with poorer weight outcomes.
Collapse
Affiliation(s)
| | | | - Carlos Grilo
- Yale School of Medicine, Psychiatry Department, New Haven, CT,Yale University, Department of Psychology, New Haven, CT
| |
Collapse
|
26
|
Wijma RB, Emous M, van den Broek M, Laskewitz A, Kobold ACM, van Beek AP. Prevalence and pathophysiology of early dumping in patients after primary Roux-en-Y gastric bypass during a mixed-meal tolerance test. Surg Obes Relat Dis 2018; 15:73-81. [PMID: 30446401 DOI: 10.1016/j.soard.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB). OBJECTIVE We performed a mixed-meal tolerance test in patients after RYGB to address the prevalence of early dumping and to gain further insight into its pathophysiology. SETTING The study was conducted in a regional hospital in the northern part of the Netherlands. METHODS From a random sample of patients who underwent primary RYGB between 2008 and 2011, 46 patients completed the mixed-meal tolerance test. The dumping severity score for early dumping was assessed every 30 minutes. A sum score at 30 or 60 minutes of ≥5 and an incremental score of ≥3 points were defined as indicating a high suspicion of early dumping. Blood samples were collected at baseline, every 10 minutes during the first half hour, and at 60 minutes after the start. RESULTS The prevalence of a high suspicion of early dumping was 26%. No differences were seen for absolute hematocrit value, inactive glucagon-like peptide-1, and vasoactive intestinal peptide between patients with or without early dumping. Patients at high suspicion of early dumping had higher levels of active glucagon-like peptide-1 and peptide YY. CONCLUSION The prevalence of complaints at high suspicion of early dumping in a random population of patients after RYGB is 26% in response to a mixed-meal tolerance test. Postprandial increases in both glucagon-like peptide-1 and peptide YY are associated with symptoms of early dumping, suggesting gut L-cell overactivity in this syndrome.
Collapse
Affiliation(s)
- Ragnhild B Wijma
- Department of Bariatric and Metabolic Surgery, Heelkunde Friesland Groep, Medical Center Leeuwarden, Leewarden, the Netherlands
| | - Marloes Emous
- Department of Bariatric and Metabolic Surgery, Heelkunde Friesland Groep, Medical Center Leeuwarden, Leewarden, the Netherlands.
| | - Merel van den Broek
- Department of Endocrinology, Medical Center Leeuwarden, Leewarden, the Netherlands
| | - Anke Laskewitz
- Certe Laboratories, Medical Center Leeuwarden, Leewarden, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - André P van Beek
- Department of Bariatric and Metabolic Surgery, Heelkunde Friesland Groep, Medical Center Leeuwarden, Leewarden, the Netherlands; Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
27
|
Emous M, Wolffenbuttel BH, van Dijk G, Totté E, van Beek AP. Long-term self-reported symptom prevalence of early and late dumping in a patient population after sleeve gastrectomy, primary, and revisional gastric bypass surgery. Surg Obes Relat Dis 2018; 14:1173-1181. [DOI: 10.1016/j.soard.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/08/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
|
28
|
Seki Y, Kasama K, Umezawa A, Kurokawa Y. Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Type 2 Diabetes Mellitus. Obes Surg 2018; 26:2035-2044. [PMID: 26749411 DOI: 10.1007/s11695-016-2057-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB), which has been positioned as a novel bariatric procedure, is the combination of vertical sleeve gastrectomy and proximal intestinal bypass and is theoretically expected to have strong anti-diabetic effect. Also, preserving the pylorus, a physiological valve, leads to less occurrence of dumping syndrome and anastomotic stenosis which are often problematic after laparoscopic Roux-en-Y gastric bypass (LRYGB), a gold standard. The purpose of this study was to investigate the clinical effects of LSG-DJB on obese patients with type 2 diabetes mellitus (T2DM). METHODS Consecutive 75 obese patients (female 44/male 31) associated with T2DM who underwent LSG-DJB and were followed up for at least 1 year were analyzed. The mean age was 45.5 ± 8.6 years, and the mean preoperative body weight (BW) and body mass index (BMI) were 108.4 ± 21.4 kg and 39.6 ± 7.3 kg/m(2), respectively. The mean hemoglobin A1c (HbA1c) at the first visit was 9.0 ± 1.9 %, and the duration of T2DM from diagnosis was 7.2 ± 6.2 years. Thirty-six out of the 75 patients (48 %) were treated with insulin preoperatively. All patients were evaluated and managed under a strict multidisciplinary team approach. The follow-up rate at 1 year was 89 %. RESULTS At 1 year, the mean BW and BMI significantly dropped to 74.6 ± 16.9 kg and 27.5 ± 5.7 kg/m(2), respectively. The mean percent of excess weight loss (%EWL) and percent of total body weight loss (%TWL) were 99.4 ± 42.4 and 31.6 ± 8.8 %, respectively. Consequently, 68.7 % of the patients achieved HbA1c less than 6 %, and 82.1 % of them achieved HbA1c less than 6.5 % without diabetes medications. Glycemic control of HbA1c less than 7 % was achieved in 91.0 % of the patients. The percentage of patients who satisfied the American Diabetes Association (ADA)-defined composite endpoints for cardiovascular disease (CVD) risk factor control increased from 0 % (at baseline) to 31 % (at 1 year). A meal tolerance test revealed significant reduction of glucose area under the curve (AUC) and increase of insulin AUC postoperatively. CONCLUSIONS LSG-DJB for obese patients with T2DM has strong anti-diabetic effect in the short-term; however, a larger number of patients with a longer follow-up period are needed for definitive conclusions.
Collapse
Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Akiko Umezawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| |
Collapse
|
29
|
Novodvorsky P, Walkinshaw E, Rahman W, Gordon V, Towse K, Mitchell S, Selvarajah D, Madhuvrata P, Munir A. Experience with FreeStyle Libre Flash glucose monitoring system in management of refractory dumping syndrome in pregnancy shortly after bariatric surgery. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170128. [PMID: 29302329 PMCID: PMC5744619 DOI: 10.1530/edm-17-0128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022] Open
Abstract
Bariatric surgery is an effective therapy for obesity but is associated with long-term complications such as dumping syndromes and nutritional deficiencies. We report a case of a 26-year-old caucasian female, with history of morbid obesity and gestational diabetes (GDM), who became pregnant 4 months after Roux-en-Y bypass surgery. She developed GDM during subsequent pregnancy, which was initially managed with metformin and insulin. Nocturnal hypoglycaemia causing sleep disturbance and daytime somnolence occured at 19 weeks of pregnancy (19/40). Treatment with rapid-acting carbohydrates precipitated further hypoglycaemia. Laboratory investigations confirmed hypoglycaemia at 2.2 mmol/L with appropriately low insulin and C-peptide, intact HPA axis and negative IgG insulin antibodies. The patient was seen regularly by the bariatric dietetic team but concerns about compliance persisted. A FreeStyle Libre system was used from 21/40 enabling the patient a real-time feedback of changes in interstitial glucose following high or low GI index food intake. The patient declined a trial of acarbose but consented to an intraveneous dextrose infusion overnight resulting in improvement but not complete abolishment of nocturnal hypoglycaemia. Hypoglycaemias subsided at 34/40 and metformin and insulin had to be re-introduced due to high post-prandial blood glucose readings. An emergency C-section was indicated at 35 + 1/40 and a small-for-gestational-age female was delivered. There have been no further episodes of hypoglycaemia following delivery. This case illustrates challenges in the management of pregnancy following bariatric surgery. To our knowledge, this is the first use of FreeStyle Libre in dumping syndrome in pregnancy following bariatric surgery with troublesome nocturnal hypoglycaemia.
Collapse
Affiliation(s)
- Peter Novodvorsky
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Emma Walkinshaw
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Waliur Rahman
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Valerie Gordon
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Karen Towse
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Mitchell
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dinesh Selvarajah
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Priya Madhuvrata
- Department of Obstetrics, Gynaecology and Neonatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alia Munir
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
30
|
Novelli IR, Fonseca LG, Gomes DL, Dutra ES, Baiocchi de Carvalho KM. Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery. Nutrition 2017; 49:13-16. [PMID: 29571605 DOI: 10.1016/j.nut.2017.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/17/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome. METHODS This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old) ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL. RESULTS The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = -0.286; P = 0.033), regardless of age, educational attainment, and postoperative time. CONCLUSION The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes.
Collapse
Affiliation(s)
- Isabelle Romero Novelli
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Federal District, Brazil
| | - Laís Gomes Fonseca
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Federal District, Brazil
| | | | - Eliane Said Dutra
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Federal District, Brazil
| | - Kênia Mara Baiocchi de Carvalho
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Brasília, Federal District, Brazil.
| |
Collapse
|
31
|
Seki Y, Kasama K, Haruta H, Watanabe A, Yokoyama R, Porciuncula JPC, Umezawa A, Kurokawa Y. Five-Year-Results of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Weight Loss and Type 2 Diabetes Mellitus. Obes Surg 2017; 27:795-801. [PMID: 27644433 DOI: 10.1007/s11695-016-2372-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown. OBJECTIVE The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM. METHODS In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m2, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery. RESULTS The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period. CONCLUSION Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.
Collapse
Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Hidenori Haruta
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Atsushi Watanabe
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Renzo Yokoyama
- Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | | | - Akiko Umezawa
- Department of Surgery, Yotsuya Medical Cube, Tokyo, Japan
| | | |
Collapse
|
32
|
Van Looveren R, Mandeville Y, Logghe P, Vandendriessche K, Verbeke X, Vuylsteke P, Pattyn P, Smet B. The Effect of Dumping on Weight Loss in Conversion of Failed Restrictive Surgery: a Cross-Sectional Pilot Study. Obes Surg 2017; 28:665-670. [DOI: 10.1007/s11695-017-2906-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
33
|
Vargas EJ, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson EB, Wilson T, Neto MG, Zundel N, Mundi MS, Collazo-Clavell ML, Meera S, Abu-Lebdeh HS, Lorentz PA, Grothe KB, Clark MM, Kellogg TA, McKenzie TJ, Kendrick ML, Topazian MD, Gostout CJ, Abu Dayyeh BK. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc 2017; 32:252-259. [PMID: 28664438 DOI: 10.1007/s00464-017-5671-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Many patients who undergo bariatric surgery will experience weight regain and effective strategies are needed to help these patients. A dilated gastrojejunal anastomosis (GJA) has been associated with weight recidivism after Roux-en-Y gastric bypass surgery (RYGB). Endoscopic transoral outlet reduction (TORe) with a full thickness endoscopic suturing device (Overstitch, Apollo Endosurgery, Austin, TX) is a minimally invasive therapeutic option. The primary aim of this project was to examine the safety and long-term efficacy data from three bariatric surgery centers and to conduct a systematic review and meta-analysis of the existing literature. METHODS Patients who underwent TORe with the Overstitch device from Jan 2013 to Nov 2016 at 3 participating bariatric surgery centers were included in the multicenter analysis. For the systematic review and meta-analysis, a comprehensive search of multiple English databases was conducted. Random effects model was used. RESULTS 130 consecutive patients across three centers underwent TORe with an endolumenal suturing device. These patients (mean age 47; mean BMI 36.8) had experienced 24.6% weight regain from nadir weight after RYGB. Average weight lost at 6, 12, and 18 months after TORe was 9.31 ± 6.7 kg (N = 84), 7.75 ± 8.4 kg (N = 70), 8 ± 8.8 kg (N = 46) (p < 0.01 for all three time points), respectively. The meta-analysis included 330 patients. The pooled weight lost at 12 months was 8.4 kg (95% CI 6.5-10.3) with no significant heterogeneity across included studies (p = 0.07). Overall, 14% of patients experienced nausea, 18% had pain and 8% required a repeat EGD. No serious adverse events reported. CONCLUSION When implemented as part of a multidisciplinary intervention, TORe using endolumenal suturing is safe, reproducible, and effective approach to manage weight recidivism after RYGB and should be utilized early in the management algorithm of these patients.
Collapse
Affiliation(s)
- Eric J Vargas
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Fateh Bazerbachi
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Monika Rizk
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tarun Rustagi
- Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Andres Acosta
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Erik B Wilson
- Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Todd Wilson
- Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manoel Galvao Neto
- Surgery, Florida International University Herbert Wertheim College of Medicine, Miami Beach, FL, USA
| | - Natan Zundel
- Surgery, Florida International University Herbert Wertheim College of Medicine, Miami Beach, FL, USA
| | - Manpreet S Mundi
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Shah Meera
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - H S Abu-Lebdeh
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Paul A Lorentz
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Mark D Topazian
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher J Gostout
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
34
|
López-Serrano A, Ortiz Polo I, Sanz de la Vega J, Moreno-Osset E. Role of the gastroenterologist in the management of the obese patient. GASTROENTEROLOGÍA Y HEPATOLOGÍA (ENGLISH EDITION) 2017; 40:409-416. [DOI: 10.1016/j.gastre.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
35
|
Emous M, Wolffenbuttel BHR, Totté E, van Beek AP. The short- to mid-term symptom prevalence of dumping syndrome after primary gastric-bypass surgery and its impact on health-related quality of life. Surg Obes Relat Dis 2017. [PMID: 28624531 DOI: 10.1016/j.soard.2017.04.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Early and late dumping are complications of gastric bypass surgery. Early dumping occurs within an hour after eating, when the emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and the release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs between 1 and 3 hours after carbohydrate ingestion and is caused by an exaggerated insulin release, resulting in hypoglycemia. Almost no data are currently available on the prevalence of early and late dumping or their impact on health-related quality of life (QoL). OBJECTIVES To study the prevalence of early and late dumping in a large population of patients having undergone a primary Roux-en-Y gastric bypass (RYGB) and its effect on QoL. SETTING Cross-sectional study at a single bariatric department in the Medical Center Leeuwarden, The Netherlands between 2008 and 2011. METHODS In 2013, this descriptive cohort study approached by email or post all patients who underwent a primary RYGB in the setting between 2008 and 2011 in one hospital. These patients were asked to fill in standardized questionnaires measuring their QoL (RAND-36), anxiety and depression (HADS), fatigue (MFI-20) and any disease specific indicators of early and late dumping syndrome. RESULTS The questionnaire was completed and returned by 351 of 613 patients (57.1%) and 121 nonobese volunteers. Participants were mostly female (80%), aged 42 (40-54 years), with an excess weight loss of 76.8% [IQR 61-95] after RYGB surgery 2.3 [ IQR 1.6-3.4] years earlier. Self-reported complaints of moderate to severe intensity suggestive of early and late dumping were present in 18.8% and 11.7% of patients, respectively. Patients with early and late dumping demonstrated significantly lower scores on the RAND-36 and HADS compared with patients without dumping. No differences were seen in the MFI-20 scores between patients with or without early and late dumping. CONCLUSION In this descriptive cohort, self-reported complaints suggestive of early and late dumping of moderate-to-severe intensity were, respectively, 18.8% and 11.7% in a cohort after primary gastric bypass surgery. These complaints were associated with markedly reduced health-related QoL.
Collapse
Affiliation(s)
- Marloes Emous
- Department of Bariatric and Metabolic Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eric Totté
- Department of Bariatric and Metabolic Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
36
|
Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up. Surg Obes Relat Dis 2017; 13:1562-1571. [PMID: 28579205 DOI: 10.1016/j.soard.2017.03.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/27/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Having accurate information on bariatric surgery-related gastrointestinal (GI) symptoms is critical for patient care. OBJECTIVE To report on surgery-related GI symptoms over the first 3 years following Roux-en-Y gastric bypass and laparoscopic adjustable gastric band. SETTING Three academic medical centers in the United States. METHODS As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 183 participants (pre-surgery median body mass index = 45.1 kg/m2; median age = 46 yr; 83.1% female). completed the Eating Disorder Examination-Bariatric Surgery Version interview at≥1 annual assessment. Patients self-reported frequency of dysphagia, dumping syndrome, and spontaneous vomiting. RESULTS Prevalence of dysphagia at least once weekly decreased post-laparoscopic adjustable gastric band surgery from 43.9% (95% confidence interval [CI], 32.2-55.6) in year 1 to 27.5% (95% CI, 15.2-39.9) in year 3 (P = .02). Dysphagia and dumping at least once weekly also appeared to decrease in years 1-3 post-Roux-en-Y gastric bypass (i.e., from 16.7% [95% CI, 9.4-24.1] to 10.9% [95% CI, 4.0-17.8] and from 9.9% [95% CI, 4.3-15.5] to 6.3% [95% CI, 1.7-10.9], respectively), but power was limited to evaluate trends. Vomiting at least once weekly was rare (<6%) in years 1-3 following both procedures. Controlling for potential confounders and surgical procedure, loss of control eating at least once weekly was associated with higher risk of at least once weekly dysphagia (relative risk = 2.01, 95% CI, 1.36-2.99, P = .001). CONCLUSIONS The prevalence of bariatric surgery-related GI symptoms appears to decrease across follow-up. Symptoms were associated with loss of control eating, suggesting a target for clinical intervention.
Collapse
|
37
|
Beamish AJ, Reinehr T. Should bariatric surgery be performed in adolescents? Eur J Endocrinol 2017; 176:D1-D15. [PMID: 28174231 DOI: 10.1530/eje-16-0906] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/08/2016] [Accepted: 01/10/2017] [Indexed: 12/26/2022]
Abstract
Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.
Collapse
Affiliation(s)
- Andrew J Beamish
- Department of Gastrosurgical ResearchInstitute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
- Research DepartmentThe Royal College of Surgeons of England, London, UK
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents University of Witten/Herdecke Department of Pediatric EndocrinologyDiabetes, and Nutrition Medicine, Datteln, Germany
| |
Collapse
|
38
|
Abstract
RATIONALE Postprandial hyperinsulinemic hypoglycemia, known as late dumping syndrome, is a rare but often misdiagnosed complication after gastric surgery. The pathophysiological mechanisms are poorly understood and the treatment of this syndrome is challenging. PATIENT CONCERNS New-onset postsurgical late dumping syndrome after Toupet fundoplication. DIAGNOSES Sigstad Score, OGTT, CGM. INTERVENTIONS Daily subcutaneous injection of liraglutide (0.6 mg and 1.2 mg). OUTCOMES Reduction in fasting and postprandial peak insulin level with improvement in symptomatic hypoglycemic events. LESSONS Liraglutide may be a novel treatment option for postprandial hyperinsulinemic hypoglycemia after gastric surgery.
Collapse
|
39
|
Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr 2017; 8:382-394. [PMID: 28298280 PMCID: PMC5347111 DOI: 10.3945/an.116.014258] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
Collapse
Affiliation(s)
- Shiri Sherf Dagan
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, and
| | - Ariela Goldenshluger
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Globus
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Chaya Schweiger
- The Israel Dietetic Association, Herzliya, Israel
- Herzliya Medical Center, Herzliya, Israel
- Nutrition Service, Rabin Medical Center, Petach Tiqva, Israel; and
| | - Yafit Kessler
- The Israel Dietetic Association, Herzliya, Israel
- The Israeli Center for Bariatric Surgery of Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Galit Kowen Sandbank
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel;
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| |
Collapse
|
40
|
Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts 2017; 10:597-632. [PMID: 29207379 PMCID: PMC5836195 DOI: 10.1159/000481825] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
Collapse
Affiliation(s)
- Luca Busetto
- Department of Internal Medicine, University of Padova, Padova, Italy
- *Prof. Dr. Luca Busetto, Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy,
| | - Dror Dicker
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- University College London Hospital Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Nathalie Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust and Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johann Kinzl
- Department of Psychiatry and Psychotherapy II, Medical University Innsbruck, Innsbruck, Austria
| | | | - Janine M. Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Karin Schindler
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
41
|
van Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev 2017; 18:68-85. [PMID: 27749997 DOI: 10.1111/obr.12467] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/04/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs 1-3 h after carbohydrate ingestion, caused by an incretin-driven hyperinsulinemic response resulting in hypoglycemia. Clinical recommendations are needed for the diagnosis and management of dumping syndrome. METHODS A systematic literature review was performed through February 2016. Evidence-based medicine was used to develop diagnostic and management strategies for dumping syndrome. RESULTS Dumping syndrome should be suspected based on concurrent presentation of multiple suggestive symptoms after upper abdominal surgery. Suspected dumping syndrome can be confirmed using symptom-based questionnaires, glycemia measurements and oral glucose tolerance tests. First-line management of dumping syndrome involves dietary modification, as well as acarbose treatment for persistent hypoglycemia. If these approaches are unsuccessful, somatostatin analogues should be considered in patients with dumping syndrome and impaired quality of life. Surgical re-intervention or continuous enteral feeding may be necessary for treatment-refractory dumping syndrome, but outcomes are variable. CONCLUSIONS Implementation of these diagnostic and treatment recommendations may improve dumping syndrome management.
Collapse
Affiliation(s)
- A P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Emous
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - M Laville
- European Center for Nutrition and Health (CENS), University of Lyon, 1 Civil Hospices of Lyon, Lyon, France
| | - J Tack
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| |
Collapse
|
42
|
Vangoitsenhoven R, Frederiks P, Gijbels B, Lannoo M, Van der Borght W, Van den Eynde A, Mertens A, Mathieu C, Van der Schueren B. Long-term effects of gastric bypass surgery on psychosocial well-being and eating behavior: not all that glitters is gold. Acta Clin Belg 2016; 71:395-402. [PMID: 27141920 DOI: 10.1080/17843286.2016.1174393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this pilot study was to evaluate long-term effects of Roux-en-Y gastric bypass (RYGB) on physical and psychosocial health as well as eating behavior of obese patients. METHODS We compared 23 patients 7 years after RYGB to 23 body mass index (BMI), sex, and age matched obese control patients by means of self-reporting questionnaires: Hospital Anxiety and Depression Scale (HADS), Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q SF), Dutch Eating Behavior Questionnaire (DEBQ), and Alcohol Use Disorders Identification Test (AUDIT). Data are presented as median ± interquartile rage. RESULTS Physical health had improved and body image (80 ± 25% vs. 20 ± 49%, p < 0.001) was better in post-RYGB patients when compared to controls. HADS-depression score (4 ± 8 vs. 11 ± 9; p = 0.005) was lower post-RYGB. Satisfaction with physical health (2 ± 2 vs. 2 ± 1, p = 0.037), daily life functioning (4 ± 2 vs. 2 ± 2, p = 0.050), and hobbies (4 ± 1 vs. 2 ± 2, p = 0.011) was higher post-RYGB, but social relationships and sexual performance were not perceived as superior. In addition, post-RYGB patients were more prone to eat on external cues (13 ± 7 vs. 19 ± 13; p = 0.007). CONCLUSION Seven years post-RYGB, patients reported a significant improvement of physical health and higher satisfaction with daily life, but not with social relationships or sexual performance. Eating behavior post-RYGB was more influenced by external cues.
Collapse
|
43
|
|
44
|
López-Serrano A, Ortiz Polo I, Sanz de la Vega J, Moreno-Osset E. Role of the gastroenterologist in the management of the obese patient. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:409-416. [PMID: 27745965 DOI: 10.1016/j.gastrohep.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/18/2016] [Accepted: 08/28/2016] [Indexed: 02/07/2023]
Abstract
Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.
Collapse
Affiliation(s)
- Antonio López-Serrano
- Servicio de Medicina Digestiva, Hospital Universitari Dr. Peset, Valencia, España; Universitat de València, Valencia, España.
| | | | | | - Eduardo Moreno-Osset
- Servicio de Medicina Digestiva, Hospital Universitari Dr. Peset, Valencia, España; Universitat de València, Valencia, España
| |
Collapse
|
45
|
Laurenius A, Engström M. Early dumping syndrome is not a complication but a desirable feature of Roux-en-Y gastric bypass surgery. Clin Obes 2016; 6:332-40. [PMID: 27487971 DOI: 10.1111/cob.12158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/27/2016] [Accepted: 07/03/2016] [Indexed: 12/31/2022]
Abstract
Early dumping syndrome after gastric bypass surgery due to rapid delivery of hyperosmolar nutrients into the bowel causing intense symptoms is often described as a complication. Twelve patients, mean age 47 years, were interviewed approximately 9 years post-operation. The interviews were audiotaped and transcribed verbatim, followed by an inductive content analysis to reveal patients' experience of the dumping syndrome. The core category 'Dumping syndrome is a positive consequence of Roux-en-Y gastric bypass surgery and a tool to control food intake' was identified based on the following four sub-categories: (i) 'The multidimensional emergence and effects of dumping syndrome', (ii) 'Dumping syndrome as something positive although unpleasant', (iii) 'Developing coping mechanisms and ingenious strategies' and (iv) 'My own fault if I expose myself to dumping syndrome'. From the patients' perspective, dumping syndrome gives control over food intake; although the symptoms were unpleasant, patients considered dumping syndrome as a positive protection against over-consumption. Hence, healthcare professionals should not present dumping syndrome as a complication but rather as an aid to control eating behaviour and excessive food intake.
Collapse
Affiliation(s)
- A Laurenius
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - M Engström
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
46
|
Opozda M, Chur-Hansen A, Wittert G. Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies. Obes Rev 2016; 17:770-92. [PMID: 27296934 DOI: 10.1111/obr.12425] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 12/31/2022]
Abstract
Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure. Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed. Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re-increases were noted, short to medium-term reductions after RYGB were common, and reported changes after AGB were inconsistent. Short to medium-term reductions in emotional eating, and from a few studies, short to long-term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low-quality evidence. Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours.
Collapse
Affiliation(s)
- M Opozda
- School of Psychology, University of Adelaide, Adelaide, Australia.,Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - A Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - G Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, Australia, and Centre for Nutrition and Gastro-Intestinal Diseases, South Australian Health and Medicine Research Institute, Adelaide, Australia
| |
Collapse
|
47
|
Endoluminal Revision (OverStitch TM , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass. Obes Surg 2016; 26:1978-84. [DOI: 10.1007/s11695-016-2266-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
48
|
Bhatti JA, Nathens AB, Thiruchelvam D, Redelmeier DA. Weight loss surgery and subsequent emergency care use: a population-based cohort study. Am J Emerg Med 2016; 34:861-5. [DOI: 10.1016/j.ajem.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 01/01/2023] Open
|
49
|
Nielsen JB, Pedersen AM, Gribsholt SB, Svensson E, Richelsen B. Prevalence, severity, and predictors of symptoms of dumping and hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 12:1562-1568. [PMID: 27425831 DOI: 10.1016/j.soard.2016.04.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/19/2016] [Accepted: 04/17/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) results in pronounced weight loss in morbidly obese patients but may also cause adverse effects like early dumping and hypoglycemia. Prevalence data on these complications and their potential predictors are sparse. OBJECTIVE To assess the prevalence and possible predictors of early dumping and hypoglycemia in a population-based cohort of RYGB patients. SETTING University Hospital, Denmark. DESIGN A questionnaire survey was performed in the Central Denmark Region including RYGB-operated patients (years 2006-2011, n = 2238) and a nonoperated comparison cohort (n = 89). The Dumping Rating Scale and the Edinburgh Hypoglycemia Scoring System, together with demographic and clinical characteristics, were used, and possible predictors were examined by logistic regression. RESULTS The response rate was 64% (1429/2238). In total, 9.4% (134/1429) and 6.6% (95/1429) experienced moderate or severe symptoms of early dumping and hypoglycemia, respectively, which were significantly higher than in the comparison cohort. Because 3.4% (95% CI: 2.5-4.4) of the RYGB group experienced both early dumping and hypoglycemia, the total prevalence of 1 or both conditions was 12.6 (95% CI 10.9-14.4). Possible predictors for both conditions were body mass index (BMI)<25 kg/m2 (odds ratio [OR] 1.70 (95% CI: 0.98-2.95) and OR 1.60 (95% CI: .83-3.06), respectively) compared with patients with BMI 25-30 kg/m2. Younger age seemed to increase the risk of both conditions (<35 yr: OR 1.75 (95% CI: 1.11-2.75) and OR .59 (95% CI: .93-2.72), respectively) compared with patients>45 years. CONCLUSION Symptoms of early dumping and hypoglycemia were rather common with a prevalence of 1 or both conditions of 12.6% after RYGB. Predictors included younger age and a lower BMI.
Collapse
Affiliation(s)
- Joan Bach Nielsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Ane Matilde Pedersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sigrid Bjerge Gribsholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Svensson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
50
|
Emous M, Ubels FL, van Beek AP. Diagnostic tools for post-gastric bypass hypoglycaemia. Obes Rev 2015; 16:843-56. [PMID: 26315925 DOI: 10.1111/obr.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 12/15/2022]
Abstract
In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tests aimed at making a diagnosis of post-gastric bypass hypoglycaemia and to provide a diagnostic approach based upon the available evidence. A search was conducted in PubMed, Cochrane and Embase. A few questionnaires have been developed to measure the severity of symptoms in post-gastric bypass hypoglycaemia but none has been validated. The gold standard for provocation of a hypoglycaemic event is the oral glucose tolerance test or the liquid mixed meal tolerance test. Both show a high prevalence of hypoglycaemia in post-gastric bypass patients with and without hypoglycaemic complaints as well as in healthy volunteers. No uniformly established cut-off values for glucose concentrations are defined in the literature for the diagnosis of post-gastric bypass hypoglycaemia. For establishing an accurate diagnosis of post-gastric bypass hypoglycaemia, a validated questionnaire, in connection with the diagnostic performance of provocation tests, is the most important thing missing. Given these shortcomings, we provide recommendations based upon the current literature.
Collapse
Affiliation(s)
- M Emous
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F L Ubels
- Department of Endocrinology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A P van Beek
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.,Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|