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Brown WA, Liem R, Al-Sabah S, Anvari M, Boza C, Cohen RV, Ghaferi A, Våge V, Himpens J, Kow L, Morton J, Musella M, Pattou F, Sakran N, Clapp B, Prager G, Shikora S. Metabolic Bariatric Surgery Across the IFSO Chapters: Key Insights on the Baseline Patient Demographics, Procedure Types, and Mortality from the Eighth IFSO Global Registry Report. Obes Surg 2024; 34:1764-1777. [PMID: 38592648 PMCID: PMC11031475 DOI: 10.1007/s11695-024-07196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION The International Federation for Surgery for Obesity and Metabolic Disorders (IFSO) Global Registry aims to provide descriptive data about the caseload and penetrance of surgery for metabolic disease and obesity in member countries. The data presented in this report represent the key findings of the eighth report of the IFSO Global Registry. METHODS All existing Metabolic and Bariatric Surgery (MBS) registries known to IFSO were invited to contribute to the eighth report. Aggregated data was provided by each MBS registry to the team at the Australia and New Zealand Bariatric Surgery Registry (ANZBSR) and was securely stored on a Redcap™ database housed at Monash University, Melbourne, Australia. Data was checked for completeness and analyzed by the IFSO Global Registry Committee. Prior to the finalization of the report, all graphs were circulated to contributors and to the global registry committee of IFSO to ensure data accuracy. RESULTS Data was received from 24 national and 2 regional registries, providing information on 502,150 procedures. The most performed primary MBS procedure was sleeve gastrectomy, whereas the most performed revisional MBS procedure was Roux-en-Y gastric bypass. Asian countries reported people with lower BMI undergoing MBS along with higher rates of diabetes. Mortality was a rare event. CONCLUSION Registries enable meaningful comparisons between countries on the demographics, characteristics, operation types and approaches, and trends in MBS procedures. Reported outcomes can be seen as flags of potential issues or relationships that could be studied in more detail in specific research studies.
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Affiliation(s)
- Wendy A Brown
- Department of Surgery, Australia and New Zealand Bariatric Surgery Registry, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
| | - Ronald Liem
- Dutch Audit for the Treatment of Obesity, Heerlen, Netherlands
| | - Salman Al-Sabah
- Department of Surgery, Kuwait University (Kuwait Bariatric Surgery Registry), Kuwait, Kuwait
| | | | - Camilo Boza
- Bariatric Surgery Center, Clinica MEDS (Chilean Bariatric Surgery Registry), Santiago, Chile
| | - Ricardo V Cohen
- The Center for the treatment of Obesity and Diabetes - COD Hospital Oswaldo Cruz (Brazilian Registry), Sao Paulo, Brazil
| | - Amir Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Villy Våge
- Scandinavian Obesity Surgery Registry Norway (SOReg-N), Helse Bergen Health Trust, Bergen, Norway
| | | | - Lilian Kow
- Department GI Surgery, Flinders University South Australia (Australian and New Zealand Bariatric Surgery Registry), Adelaide, Australia
| | - John Morton
- Yale School of Medicine (MBSAQIP- Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project), New Haven, CT, USA
| | - Mario Musella
- Advanced Biomedical Sciences Department (Italian Registry), Naples "Federico II" University, Naples, Italy
| | - Francois Pattou
- University of Lille, Integrated Center for Obesity, CHU Lille, Inserm,, Institut Pasteur Lille (SOFFCO-MM Registry), Lille, France
| | - Nasser Sakran
- Department of General Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University (Israelian Registry), Ramat Gan, Israel
| | - Benjamin Clapp
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79902, USA
| | - Gerhard Prager
- Universitätsklinik Für Allgemeinchirurgie, Vienna, Austria
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Harvard Medical School (MBSAQIP), Boston, MA, USA
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Lyyjynen HS, Andersen JR, Liem RSL, Mala T, Nienhuijs SW, Ottosson J, Sundbom M, Thorell A, Våge V. Surgical Aspects of Sleeve Gastrectomy Are Related to Weight Loss and Gastro-esophageal Reflux Symptoms. Obes Surg 2024; 34:902-910. [PMID: 38329707 PMCID: PMC10899332 DOI: 10.1007/s11695-023-07018-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION A large variation in outcome has been reported after sleeve gastrectomy (SG) across countries and institutions. We aimed to evaluate the effect of surgical technique on total weight loss (TWL) and gastro-esophageal reflux disease (GERD). METHODS Observational cohort study based on data from the national registries for bariatric surgery in the Netherlands, Norway, and Sweden. A retrospective analysis of prospectively obtained data from surgeries during 2015-2017 was performed based on 2-year follow-up. GERD was defined as continuous use of acid-reducing medication. The relationship between TWL, de novo GERD and operation technical variables were analyzed with regression methods. RESULTS A total of 5927 patients were included. The average TWL was 25.6% in Sweden, 28.6% in the Netherlands, and 30.6% in Norway (p < 0.001 pairwise). Bougie size, distance from the resection line to the pylorus and the angle of His differed between hospitals. A minimized sleeve increased the expected total weight loss by 5-10 percentage points. Reducing the distance to the angle of His from 3 to just above 0 cm increased the risk of de novo GERD five-fold (from 3.5 to 17.8%). CONCLUSION Smaller bougie size, a shorter distance to pylorus and to the angle of His were all associated with greater weight loss, whereas a shorter distance to angle of His was associated with more de novo reflux.
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Affiliation(s)
| | - John R Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
- Nederlandse Obesitas Kliniek (NOK) in The Hague and Gouda, The Hague and Gouda, Netherlands
| | - Tom Mala
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Johan Ottosson
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
- Department of Surgery and Anesthesia, Ersta Hospital, Stockholm, Sweden
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
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Våge V. Does Gastric Bypass Have a Weight Loss-Independent Mechanism for Remission of Type 2 Diabetes? Obes Surg 2024; 34:1026. [PMID: 38159145 DOI: 10.1007/s11695-023-07005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Villy Våge
- Helse Bergen Health Trust, Bergen, Norway.
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Chahal-Kummen M, Våge V, Kristinsson JA, Mala T. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis 2023; 19:819-829. [PMID: 36870870 DOI: 10.1016/j.soard.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes. OBJECTIVE To compare the prevalence of patient-reported chronic abdominal pain (CAP) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Secondarily, we compared other abdominal and psychological symptoms and quality of life (QoL). Preoperative predictors of postoperative CAP were also explored. SETTING Tertiary referral centers for bariatric surgery in Norway. METHODS Analyses of 2 separate prospective longitudinal cohort studies evaluating CAP, abdominal and psychological symptoms and QoL before and 2 years after RYGB and SG. RESULTS Follow-ups were attended by 416 patients (85.8%), 300/416 (72.1%) were females and 209/416 (50.2%) were RYGB procedures. At follow-up, the mean age was 44.9 (10.0) years, BMI 29.5 (5.4) kg/m2, and total weight loss 31.6 (10.3) %. The prevalence of CAP was 28/236 (11.9%) before and 60/209 (28.7%) after RYGB (P < .001) and 32/223 (14.3%) before and 50/186 (26.9%) after SG (P < .001). Gastrointestinal symptom rating scale scores showed greater deterioration of diarrhea and indigestion after RYGB and reflux after SG. The improvement in depression symptoms was greater after SG, as well as several QoL scores improved more after SG. Patients with CAP after RYGB experienced deterioration in several QoL scores, while these scores improved in patients with CAP after SG. Preoperative hypertension, bothersome reflux symptoms, and CAP predicted postoperative CAP. CONCLUSIONS The prevalence of CAP increased comparably after RYGB and SG, with worsening of gastroesophageal reflux after SG and greater deterioration of diarrhea and indigestion after RYGB. In patients with CAP at follow-up, several QoL scores improved more after SG than RYGB.
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Affiliation(s)
- Monica Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine and Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Welbourn R, Hollyman M, Kinsman R, Dixon J, Cohen R, Morton J, Ghaferi A, Higa K, Ottosson J, Pattou F, Al-Sabah S, Anvari M, Himpens J, Liem R, Våge V, Walton P, Brown W, Kow L. Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015-2018. Obes Surg 2021; 31:2391-2400. [PMID: 33638756 PMCID: PMC8113173 DOI: 10.1007/s11695-021-05280-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry. MATERIALS AND METHODS Cross-sectional analysis of patients having primary surgery in 2015-2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records. RESULTS Fifteen countries including 11 national registries met the inclusion criteria. The rate of T2DM was 24.2% (99,537 of 411,581 patients, country range 12.0-55.1%) and 77.1% of all patients were women. In every country, patients with T2DM were older than those without T2DM (overall mean age 49.2 [SD 11.4] years vs 41.8 [11.9] years, all p < 0.001). Men were more likely to have T2DM than women, odds ratio (OR) 1.68 (95% CI 1.65-1.71), p < 0.001. Men showed higher rates of T2DM for BMI <35 kg/m2 compared to BMI ≥35.0 kg/m2, OR 2.76 (2.52-3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73-0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63-0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67-1.72), p < 0.001. CONCLUSION Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m2 and increased likelihood of food rerouting operations.
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Affiliation(s)
- Richard Welbourn
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
| | - Marianne Hollyman
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Robin Kinsman
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - John Dixon
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
| | - Ricardo Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - John Morton
- Division Chief, Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Amir Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | | | - Salman Al-Sabah
- Al-Amiri Hospital Kuwait, Royale Hyatt Hospital, Kuwait City, Kuwait
| | - Merhan Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Peter Walton
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - Wendy Brown
- Centre of Obesity Research and Education, Monash University, Melbourne, Australia
| | - Lilian Kow
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Jersin RÅ, Tallapragada DSP, Madsen A, Skartveit L, Fjære E, McCann A, Lawrence-Archer L, Willems A, Bjune JI, Bjune MS, Våge V, Nielsen HJ, Thorsen HL, Nedrebø BG, Busch C, Steen VM, Blüher M, Jacobson P, Svensson PA, Fernø J, Rydén M, Arner P, Nygård O, Claussnitzer M, Ellingsen S, Madsen L, Sagen JV, Mellgren G, Dankel SN. Role of the Neutral Amino Acid Transporter SLC7A10 in Adipocyte Lipid Storage, Obesity, and Insulin Resistance. Diabetes 2021; 70:680-695. [PMID: 33408126 DOI: 10.2337/db20-0096] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022]
Abstract
Elucidation of mechanisms that govern lipid storage, oxidative stress, and insulin resistance may lead to improved therapeutic options for type 2 diabetes and other obesity-related diseases. Here, we find that adipose expression of the small neutral amino acid transporter SLC7A10, also known as alanine-serine-cysteine transporter-1 (ASC-1), shows strong inverse correlates with visceral adiposity, insulin resistance, and adipocyte hypertrophy across multiple cohorts. Concordantly, loss of Slc7a10 function in zebrafish in vivo accelerates diet-induced body weight gain and adipocyte enlargement. Mechanistically, SLC7A10 inhibition in human and murine adipocytes decreases adipocyte serine uptake and total glutathione levels and promotes reactive oxygen species (ROS) generation. Conversely, SLC7A10 overexpression decreases ROS generation and increases mitochondrial respiratory capacity. RNA sequencing revealed consistent changes in gene expression between human adipocytes and zebrafish visceral adipose tissue following loss of SLC7A10, e.g., upregulation of SCD (lipid storage) and downregulation of CPT1A (lipid oxidation). Interestingly, ROS scavenger reduced lipid accumulation and attenuated the lipid-storing effect of SLC7A10 inhibition. These data uncover adipocyte SLC7A10 as a novel important regulator of adipocyte resilience to nutrient and oxidative stress, in part by enhancing glutathione levels and mitochondrial respiration, conducive to decreased ROS generation, lipid accumulation, adipocyte hypertrophy, insulin resistance, and type 2 diabetes.
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Affiliation(s)
- Regine Å Jersin
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Divya Sri Priyanka Tallapragada
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - André Madsen
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Linn Skartveit
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Even Fjære
- Institute of Marine Research, Bergen, Norway
| | | | - Laurence Lawrence-Archer
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Aron Willems
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Jan-Inge Bjune
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Mona S Bjune
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Villy Våge
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
| | | | | | - Bjørn Gunnar Nedrebø
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | | | - Vidar M Steen
- NORMENT, K.G. Jebsen Center for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. E. Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Matthias Blüher
- Clinic for Endocrinology and Nephrology, Medical Research Center, Leipzig, Germany
| | - Peter Jacobson
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Fernø
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Peter Arner
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Ottar Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Melina Claussnitzer
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ståle Ellingsen
- Institute of Marine Research, Bergen, Norway
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - Lise Madsen
- Institute of Marine Research, Bergen, Norway
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jørn V Sagen
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Bergen Stem Cell Consortium, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Simon N Dankel
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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Våge V. Selecting a metabolic procedure. Surg Obes Relat Dis 2020; 16:1879. [PMID: 32943321 DOI: 10.1016/j.soard.2020.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Villy Våge
- Scandinavian Obesity Surgery Registry, Helse Bergen Health Thrust, Bergen, Norway, Norway
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Poelemeijer YQM, Liem RSL, Våge V, Mala T, Sundbom M, Ottosson J, Nienhuijs SW. Gastric Bypass Versus Sleeve Gastrectomy: Patient Selection and Short-term Outcome of 47,101 Primary Operations From the Swedish, Norwegian, and Dutch National Quality Registries. Ann Surg 2020; 272:326-333. [PMID: 32675546 DOI: 10.1097/sla.0000000000003279] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. BACKGROUND Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. METHODS Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. RESULTS A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. CONCLUSION This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.
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Affiliation(s)
- Youri Q M Poelemeijer
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, Netherlands
- Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
| | - Ronald S L Liem
- Groene Hart Hospital, Department of Surgery, Gouda, Netherlands
- Dutch Obesity Clinic, The Hague, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Tom Mala
- Oslo University Hospital, Department of Gastrointestinal Surgery, Oslo, Norway
| | - Magnus Sundbom
- Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| | - Johan Ottosson
- Örebro University Hospital, Department of Surgery, Örebro, Sweden
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Våge V, Behme J, Jossart G, Andersen J. Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study. Int J Surg 2020; 74:113-117. [DOI: 10.1016/j.ijsu.2019.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/11/2019] [Accepted: 12/24/2019] [Indexed: 01/30/2023]
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Abstract
OBJECTIVES Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery procedure worldwide, but reports on long-term quality of life (QOL) outcomes are scarce. We investigated 5-year trajectories in QOL and their associations with weight loss after SG. DESIGN A prospective cohort study. SETTING The study was conducted in a single Norwegian bariatric surgery centre. PARTICIPANTS Out of 150 operated patients, 127 were included. Mean age was 41 years, 68% were women and the follow-up rate at 1 year was 85% and 64% at 1 and 5 years, respectively. OUTCOME MEASURES Data were collected preoperatively, and 1 and 5 years after surgery assessing three different levels of QOL. The main exposure was weight loss after SG, assessed as per cent excess body mass index (kg/m2) loss (%EBMIL). The Obesity-Related Problem (OP) scale was used to measure obesity-specific health-related QOL (HRQOL). Physical (PCS) and mental (MCS) composite summary scores of the Short Form 36 Health Survey were used to capture generic HRQOL and Cantril Ladder was used to assess overall QOL. RESULTS All HRQOL/overall QOL measures significantly improved at 1 year, followed by modest decline from 1 to 5 years after surgery. Greater %EBMIL 5 years after surgery was significantly associated with improvements in OP and PCS scores, but not with MCS and Cantril Ladder scores. Although significant (p<0.001) and clinically relevant improvements in HRQOL/overall QOL outcomes were observed at 5 years, scores were still below the general population norms. CONCLUSION Most patients undergoing SG experience substantial weight loss accompanied by statistically significant and clinically relevant long-term improvements in HRQOL/overall QOL. However, an important minority of patients still report low HRQOL/overall QOL 5 years after SG. Further research should aim to identify other factors that contribute to impaired QOL after bariatric surgery, even in the presence of successful weight control.
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Affiliation(s)
- Tone Nygaard Flølo
- Department of Surgery, Voss Hospital, Haukeland University Hospital, Voss, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ronette L Kolotkin
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, US
- Quality of Life Consulting, PLLC, Durham, North Carolina, US
| | - Anny Aasprang
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Tone Merete Norekvål
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Villy Våge
- Department of Surgery, Haraldsplass Diakonale Sykehus, Bergen, Norway
- Scandinavian Obesity Surgery Registry (SOReg-N), The Western Norway Health Region Authority, Bergen, Norway
| | | | - John Roger Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
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11
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Aasprang A, Våge V, Flølo TN, Hegland PA, Kolotkin R, Natvig GK, Andersen JR. Patient-reported quality of life with obesity - development of a new measurement scale. Tidsskr Nor Laegeforen 2019; 139:18-0493. [PMID: 31429227 DOI: 10.4045/tidsskr.18.0493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Many questionnaires for measuring the quality of life for patients with obesity require comprehensive calculation before they are used. There is a need for questionnaires that permit simple assessment of the responses during a patient consultation. We have developed the questionnaire Patient-Reported Outcomes in Obesity (PROS). The objective of the study was to test the reliability and validity of the questionnaire. MATERIAL AND METHOD The questionnaire was used to ask patients about the extent to which they perceived their weight or body shape as bothersome. A group of patients with an average body mass index (BMI) of 42 (n = 109) completed the PROS questionnaire and The Impact of Weight Quality of Life questionnaire (IWQOL-Lite) before undergoing obesity surgery. Another group with an average body mass index of 29 (n = 95) completed the PROS questionnaire 1-5 years after having undergone obesity surgery. 67,7 % of the patients were > 40 years and 79 % were women. For the statistical analysis we used Cronbach's alpha, factor analysis, Spearman's rank test and independent t-test. RESULTS Cronbach's alpha for the total PROS score was 0.90, and the factor analysis showed a significant factor (eigenvalue = 4.7) that explained 58.4 % of the variance. The test-retest correlation was 0.93 (p < 0.001). The correlation coefficients between the PROS score, the total IWQOL-Lite score (rs = -0.91) and body mass index (rs = 0.60) were all significant (p < 0.001). The t-test showed an effect size (difference in standard deviation) between the non-surgery and the surgery groups of 1.9 (95 % CI 1.6-2.5) for the PROS questionnaire and 2.1 (95 % CI 1.7-2.5 for the total IWQOL-Lite score. INTERPRETATION The PROS questionnaire is a reliable and valid questionnaire for measurement of obesity-specific quality of life.
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12
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Flølo TN, Tell GS, Kolotkin RL, Aasprang A, Norekvål TM, Våge V, Andersen JR. Eating self-efficacy as predictor of long-term weight loss and obesity-specific quality of life after sleeve gastrectomy: A prospective cohort study. Surg Obes Relat Dis 2019; 15:161-167. [PMID: 30709748 DOI: 10.1016/j.soard.2018.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery. OBJECTIVE We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG). SETTING A single-center longitudinal study. METHODS Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models. RESULTS Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P = .002) but did not predict postoperative %EBMIL or QOL at 55 months (β = -.08, P = .485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β = .34, P = .013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β = .46, P = .001) and obesity-specific QOL (β = .50, P < .001) 55 months after SG. CONCLUSION Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery.
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Affiliation(s)
- Tone Nygaard Flølo
- Department of Surgery, Voss Hospital, Haukeland University Hospital, Voss, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ronette L Kolotkin
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway; Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Anny Aasprang
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Tone M Norekvål
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway; Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway
| | - Villy Våge
- Department of Surgery, Haraldsplass Diaconal Hospital, Bergen, Norway; Scandinavian Obesity Surgery Registry (SOReg-N), The Western Norway Health Region Authority, Bergen, Norway
| | - John R Andersen
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Førde, Norway; Center of Health Research, Førde Hospital Trust, Førde, Norway
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13
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Bjune JI, Haugen C, Gudbrandsen O, Nordbø OP, Nielsen HJ, Våge V, Njølstad PR, Sagen JV, Dankel SN, Mellgren G. IRX5 regulates adipocyte amyloid precursor protein and mitochondrial respiration in obesity. Int J Obes (Lond) 2018; 43:2151-2162. [PMID: 30538277 PMCID: PMC6451637 DOI: 10.1038/s41366-018-0275-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/02/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022]
Abstract
Objective A causal obesity risk variant in the FTO locus was recently shown to inhibit adipocyte thermogenesis via increased adipose expression of the homeobox transcription factors IRX3 and IRX5. However, causal effects of IRX5 on fat storage remain to be shown in vivo, and discovery of downstream mediators may open new therapeutic avenues. Methods 17 WT and 13 Irx5 knockout (KO) mice were fed low-fat control (Ctr) or high-fat (HF) diet for 10 weeks. Body weight, energy intake and fat mass were measured. Irx5-dependent gene expression was explored by transcriptome analysis of epididymal white adipose tissue (eWAT), confirmatory obesity-dependent expression in human adipocytes in vivo, and in vitro knock-down, overexpression and transcriptional activation assays. Results Irx5 knock-out mice weighed less, had diminished fat mass, and were protected from diet-induced fat accumulation. Key adipose mitochondrial genes Pparγ coactivator 1-alpha (Pgc-1α) and uncoupling protein 1 (Ucp1) were upregulated, and a gene network centered on amyloid precursor protein (App) was downregulated in adipose tissue of knock-out mice and in isolated mouse adipocytes with stable Irx5 knock-down. An APP-centered network was also enriched in isolated adipocytes from obese compared to lean humans. IRX5 overexpression increased APP promoter activity and both IRX5 and APP inhibited transactivation of PGC-1α and UCP1. Knock-down of Irx5 or App increased mitochondrial respiration in adipocytes. Conclusion Irx5-KO mice were protected from obesity and this can partially be attributed to reduced adipose App and improved mitochondrial respiration. This novel Irx5-App pathway in adipose tissue is a possible therapeutic entry point against obesity.
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Affiliation(s)
- Jan-Inge Bjune
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway
| | - Christine Haugen
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway
| | - Oddrun Gudbrandsen
- Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway
| | - Ole P Nordbø
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway
| | - Hans J Nielsen
- Department of Surgery, Voss Hospital, 5704, Voss, Norway
| | - Villy Våge
- Department of Surgery, Voss Hospital, 5704, Voss, Norway
| | - Pål R Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway.,Department of Pediatrics and Adolescents, Haukeland University Hospital, 5021, Bergen, Norway
| | - Jørn V Sagen
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway.,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway
| | - Simon N Dankel
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway. .,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Gunnar Mellgren
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, 5020, Bergen, Norway. .,Hormone Laboratory, Haukeland University Hospital, 5021, Bergen, Norway.
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14
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Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Ramos A, Våge V, Al-Sabah S, Brown W, Cohen R, Walton P, Himpens J. Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg 2018; 29:782-795. [DOI: 10.1007/s11695-018-3593-1] [Citation(s) in RCA: 465] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023]
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15
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Flølo TN, Andersen JR, Kolotkin RL, Aasprang A, Natvig GK, Hufthammer KO, Våge V. Five-Year Outcomes After Vertical Sleeve Gastrectomy for Severe Obesity: A Prospective Cohort Study. Obes Surg 2018; 27:1944-1951. [PMID: 28224471 DOI: 10.1007/s11695-017-2605-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND We present 5-year outcomes after vertical sleeve gastrectomy (VSG), including complications and revisions, weight change, obesity-related diseases and health-related quality of life (HRQOL). METHODS Patients operated from December 2005 to November 2010 were included. All variables except HRQOL (obtained using Short Form-36) were assessed prospectively. HRQOL data was assessed cross-sectionally, comparing 5-year results to both a baseline cohort of severely obese patients prior to bariatric surgery and to Norwegian norms. RESULTS Of 168 operated patients (mean age, 40.3 ± 10.5 years; 71% females), 92% completed 2-year and 82% 5-year follow-up. Re-intervention for complications occurred in four patients, whereas revision surgery was performed in six patients for weight regain and in one patient for gastroesophageal reflux disease (GERD). Mean body mass index (BMI) decreased from 46.2 ± 6.4 kg/m2 at baseline to 30.5 ± 5.8 kg/m2 at 2 years and 32.9 ± 6.1 kg/m2 at 5 years. Remission of type 2 diabetes mellitus (T2DM) and hypertension occurred in 79 and 62% at 2 years, and 63 and 60% at 5 years, respectively. The percentage of patients treated for GERD increased from 12% preoperatively to 29% at 2 years and 35% at 5 years. The physical and mental SF-36 summary scores showed significantly better HRQOL at 5 years compared with the baseline cohort, but did not reach population norms. CONCLUSION The majority of VSG patients maintained successful weight loss and improvement of T2DM, hypertension and HRQOL at 5 years. Preventing weight regain and GERD are important considerations with this procedure.
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Affiliation(s)
- Tone Nygaard Flølo
- Department of Surgery, Voss Hospital, Haukeland University Hospital/The Western Norway Health Region Authority, Sjukehusvegen 16, 5704, Voss, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - John R Andersen
- Department of Surgery, Førde Hospital Trust/Western Norway University of Applied Sciences, Førde, Norway
| | - Ronette L Kolotkin
- Department of Surgery, Førde Hospital Trust/Western Norway University of Applied Sciences, Førde, Norway
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Anny Aasprang
- Department of Surgery, Førde Hospital Trust/Western Norway University of Applied Sciences, Førde, Norway
| | - Gerd K Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Karl O Hufthammer
- Competence Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Villy Våge
- Department of Surgery, Voss Hospital, Haukeland University Hospital/The Western Norway Health Region Authority, Sjukehusvegen 16, 5704, Voss, Norway
- Scandinavian Obesity Surgery Registry (SOReg-N), Haukeland University Hospital/Voss Hospital, Bergen, Norway
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16
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Christensen MHE, Fadnes DJ, Røst TH, Pedersen ER, Andersen JR, Våge V, Ulvik A, Midttun Ø, Ueland PM, Nygård OK, Mellgren G. Inflammatory markers, the tryptophan-kynurenine pathway, and vitamin B status after bariatric surgery. PLoS One 2018; 13:e0192169. [PMID: 29401505 PMCID: PMC5798786 DOI: 10.1371/journal.pone.0192169] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/17/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Obesity is associated with increased inflammation and insulin resistance. In conditions with chronic immune activation, low plasma vitamin B6-levels are described, as well as an increased kynurenine:tryptophan-ratio (KTR). We investigated circulating tryptophan, kynurenine and its metabolites, neopterin, B-vitamins, CRP, and HbA1c in individuals with obesity before and after bariatric surgery. METHODS This longitudinal study included 37 patients with severe obesity, scheduled for bariatric surgery. Blood samples were taken at inclusion and at three months and one year postoperatively. RESULTS We observed significant positive correlations between HbA1c and both 3-hydroxy-kynurenine and 3-hydroxyanthranilic acid at inclusion. After surgery, fasting glucose, HbA1C and triglycerides decreased, whereas HDL-cholesterol increased. Tryptophan, kynurenine and its metabolites, except for anthranilic acid, decreased during weight loss. The KTR and CRP decreased while vitamin B6 increased during the year following operation, indicating reduced inflammation (all p<0.05). CONCLUSIONS In patients with obesity subjected to bariatric surgery, levels of 3-hydroxykynurenine and 3-hydroxyanthranilic acid seemed to be positively correlated to impaired glucose tolerance. One year following surgery, plasma levels of the kynurenine metabolites were substantially decreased, along with a metabolic improvement. The relation of circulating kynurenine pathway metabolites with biomarkers of metabolic impairment in patients with obesity needs further evaluation.
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Affiliation(s)
- Monika H. E. Christensen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dag J. Fadnes
- Medical Department, Førde Hospital Trust, Førde, Norway
| | - Therese H. Røst
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eva R. Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John R. Andersen
- Sogn og Fjordane University College, Førde, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Villy Våge
- Center of Health Research, Førde Hospital Trust, Førde, Norway
- Department of Surgery, Voss Hospital, Bergen Health Trust, Voss, Norway
| | | | | | - Per M. Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Ottar K. Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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Gillon S, Jeanes YM, Andersen JR, Våge V. Micronutrient Status in Morbidly Obese Patients Prior to Laparoscopic Sleeve Gastrectomy and Micronutrient Changes 5 years Post-surgery. Obes Surg 2016; 27:606-612. [DOI: 10.1007/s11695-016-2313-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lin C, Andersen JR, Våge V, Rajalahti T, Mjøs SA, Kvalheim OM. Intensive lifestyle intervention provides rapid reduction of serum fatty acid levels in women with severe obesity without lowering omega-3 to unhealthy levels. Clin Obes 2016; 6:259-67. [PMID: 27334055 PMCID: PMC5129509 DOI: 10.1111/cob.12151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/24/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
Serum fatty acid (FA) levels were monitored in women with severe obesity during intensive lifestyle intervention. At baseline, total FA levels and most individual FAs were elevated compared to a matching cohort of normal and overweight women (healthy controls). After 3 weeks of intensive lifestyle intervention, total level was only 11-12% higher than in the healthy controls and with almost all FAs being significantly lower than at baseline, but with levels of omega-3 being similar to the healthy controls. This is contrary to observations for patients subjected to bariatric surgery where omega-3 levels dropped to levels significantly lower than in the lifestyle patients and healthy controls. During the next 3 weeks of treatment, the FA levels in lifestyle patients were unchanged, while the weight loss continued at almost the same rate as in the first 3 weeks. Multivariate analysis revealed that weight loss and change of serum FA patterns were unrelated outcomes of the intervention for lifestyle patients. For bariatric patients, these processes were associated probably due to reduced dietary input and increased input from the patients' own fat deposits, causing a higher rate of weight loss and simultaneous reduction of the ratio of serum eicosapentaenoic to arachidonic acid.
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Affiliation(s)
- C Lin
- Fjordomics, Førde Hospital Trust, Førde, Norway
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - J R Andersen
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
- Center of Health research, Førde Hospital Trust, Førde, Norway
| | - V Våge
- Center of Health research, Førde Hospital Trust, Førde, Norway
- Department of Surgery, Voss Hospital, Bergen Health Trust, Voss, Norway
| | - T Rajalahti
- Fjordomics, Førde Hospital Trust, Førde, Norway
| | - S A Mjøs
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - O M Kvalheim
- Department of Chemistry, University of Bergen, Bergen, Norway
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
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Aasprang A, Andersen JR, Våge V, Kolotkin RL, Natvig GK. Psychosocial functioning before and after surgical treatment for morbid obesity: reliability and validation of the Norwegian version of obesity-related problem scale. PeerJ 2015; 3:e1275. [PMID: 26468434 PMCID: PMC4592151 DOI: 10.7717/peerj.1275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/06/2015] [Indexed: 01/12/2023] Open
Abstract
Background. The aims of this study were to translate the Obesity-Related Problem scale (OP scale) into the Norwegian language and test its reliability, validity and responsiveness in a Norwegian sample. Method. The questionnaire (OP scale) was translated from the original language (Swedish) into Norwegian. Patients completed the questionnaire prior to and one year after sleeve gastrectomy. Internal consistency was evaluated using Cronbach’s α. Construct validity was tested by correlating the OP-scale with the SF-36 and the Cantril Ladder using the Pearson correlation coefficient. An exploratory and confirmatory factor analysis was used to test the unidimensionality of the OP scale. Responsiveness was tested by assessing changes in the OP scale from baseline to one year post-surgery using the paired sample t-test. Floor and ceiling effect were calculated as percentages. Results. A total of 181 patients (123 women) accepted for bariatric surgery was included in the study. The mean age was 43.1 ± 12.5 years, and mean body mass index (BMI) before surgery was 45 ± 6.9. The mean value of the OP scale at baseline was 63.30 ± 24.43 (severe impairment) and 21.01 ± 20.98 at one year follow-up (mild impairment). Internal consistency was high at baseline (Cronbach’s α 0.91). The floor effect was small at baseline and high at one year. The ceiling effect was small at baseline and at one year. Exploratory and conformatory factor analysis showed one factor with a high percent of explained variance. Correlations between OP scale at baseline, SF-36, Cantril Ladder and BMI were statistically significant and in the predicted direction to support validity of the Norwegian OP scale. After one year correlations between the change in OP scale and the change in SF-36 scores, Cantril Ladder and BMI were also statistically significant, except for the change in the Role Physical-scale. The OP scale showed greater responsiveness than either the SF-36 or Cantril Ladder. Conclusion. These results confirm that the Norwegian version of the OP scale is a valid and reliable instrument for measuring psychosocial functioning in patients with clinically severe obesity.
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Affiliation(s)
- Anny Aasprang
- Faculty of Health Studies, Sogn og Fjordane University Collage , Førde , Norway ; Department of Global Public Health and Primary Care, University of Bergen , Bergen , Norway
| | - John Roger Andersen
- Faculty of Health Studies, Sogn og Fjordane University Collage , Førde , Norway ; Department of Surgery, Førde Central Hospital , Førde , Norway
| | - Villy Våge
- Department of Surgey, Voss Hospital, Helse Bergen Trust , Voss , Norway ; Centre for Health Research, Førde Hospital Trust , Førde , Norway
| | - Ronette L Kolotkin
- Faculty of Health Studies, Sogn og Fjordane University Collage , Førde , Norway ; Department of Surgery, Førde Central Hospital , Førde , Norway ; Department of Community and Family Medicine, Duke University School of Medicine , Durham, NC , USA ; Quality of Life Consulting, PLLC , Durham, NC , USA
| | - Gerd Karin Natvig
- Department of Global Public Health and Primary Care, University of Bergen , Bergen , Norway
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Andersen JR, Hernæs UJ, Hufthammer KO, Våge V. Employment status and sick-leave following obesity surgery: a five-year prospective cohort study. PeerJ 2015; 3:e1285. [PMID: 26468438 PMCID: PMC4592158 DOI: 10.7717/peerj.1285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/10/2015] [Indexed: 11/20/2022] Open
Abstract
Background. Severe obesity is a risk factor for lower participation in paid work, but whether employment increases and sick leave decreases after obesity surgery is not well documented. Methods. We assessed 224 Norwegian patients with severe obesity (mean age: 40; mean BMI: 49; 61% female) regarding employment status (working versus not working) and the number of days of sick leave during the preceding 12 months, before and five years after obesity surgery (75% follow-up rate). Logistic regression analysis was used to study preoperative predictors of employment status after surgery. Results. There were no change in the employment rate over time (54% versus 58%), but the number of days of sick leave per year was significantly reduced, from a mean of 63 to a mean of 26, and from a median of 36 to a median of 4. Most of this change was attributable to patients with zero days of sick leave, which increased from 25% to 41%. Being female, older, having low education level, receiving disability pension and not being employed before obesity surgery were important risk factors for not being employed after obesity surgery. The type of obesity surgery, BMI and marital status were not useful predictors. Conclusions. Our findings suggest that undergoing obesity surgery is not associated with a higher rate of employment, although it may reduce the number of days of sick leave. Additional interventions are likely needed to influence the employment status of these patients. The significant preoperative predictors of not being employed in this study provide suggestions for further research.
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Affiliation(s)
- John Roger Andersen
- Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ulrikke J.V. Hernæs
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | | | - Villy Våge
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
- Department of Surgery, Voss Hospital, Helse Bergen Health Trust, Voss, Norway
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Andersen JR, Aasprang A, Karlsen TI, Karin Natvig G, Våge V, Kolotkin RL. Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies. Surg Obes Relat Dis 2015; 11:466-73. [DOI: 10.1016/j.soard.2014.10.027] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/20/2014] [Accepted: 10/30/2014] [Indexed: 11/26/2022]
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Abstract
Background Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS. Methods Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI. Results Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P < 0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P = 0.004), but anxiety did not (P = 0.595). Conclusions This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms.
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Affiliation(s)
- Anny Aasprang
- Faculty of Health Studies, Sogn og Fjordane University College, Vievegen 2, 6800, Førde, Norway,
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Våge V, Sande VA, Mellgren G, Laukeland C, Behme J, Andersen JR. Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study. BMC Surg 2014. [PMID: 24517247 DOI: 10.1186/1471-2482-14.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To evaluate changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG). METHODS We started the procedure in May 2007, and by December 2011, 117 patients could be evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients. RESULTS Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomatic gastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively. CONCLUSIONS LSG is an effective procedure for morbid obesity and obesity-related diseases, but the technique should be further explored particularly to avoid gastroesophageal reflux.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Førde Central Hospital, 6807 Førde, Norway.
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Våge V, Sande VA, Mellgren G, Laukeland C, Behme J, Andersen JR. Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study. BMC Surg 2014; 14:8. [PMID: 24517247 PMCID: PMC3923733 DOI: 10.1186/1471-2482-14-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 02/05/2014] [Indexed: 12/19/2022] Open
Abstract
Background To evaluate changes in obesity-related diseases and micronutrients after laparoscopic sleeve gastrectomy (LSG). Methods We started the procedure in May 2007, and by December 2011, 117 patients could be evaluated for a two year follow-up. Comparisons of preoperative status with 12 and 24 months postoperative status were made for body mass index (BMI), obesity-related diseases and micronutrients. Results Major complications included bleeding requiring transfusion at 5.1%, leak at 1.7% and abscess without a visible leak at 0.9%. Mean BMI was reduced from 46.6 (standard deviation (SD) 6.0) kg/m2 to 30.6 (SD 5.6) kg/m2 at two years, and resolution occurred for 80.7% of patients with type 2 diabetes, 63.9% with hypertension, 75.8% with hyperlipidemia, 93.0% with sleep apnea, 31.4% with musculoskeletal pain, 85.4% with snoring and 73.3% with urinary incontinence. Amenorrhea resolved in all premenopausal females. The proportion of patients with symptomatic gastroesophageal reflux disease increased from 12.8% to 27.4%. The prevalence of patients with low ferritin-levels increased, while 25-hydroxyvitamin D (25(OH)D) deficiency decreased postoperatively. Conclusions LSG is an effective procedure for morbid obesity and obesity-related diseases, but the technique should be further explored particularly to avoid gastroesophageal reflux.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Førde Central Hospital, 6807 Førde, Norway.
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Methlie P, Dankel S, Myhra T, Christensen B, Gjerde J, Fadnes D, Våge V, Løvås K, Mellgren G. Changes in adipose glucocorticoid metabolism before and after bariatric surgery assessed by direct hormone measurements. Obesity (Silver Spring) 2013; 21:2495-503. [PMID: 23512832 DOI: 10.1002/oby.20449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/21/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Increased intra-adipose cortisol is thought to promote obesity, but few human studies have investigated intra-adipose glucocorticoid hormones and none have demonstrated prospective changes with fat loss. DESIGN AND METHODS Subcutaneous adipose tissue (SAT) was obtained from obese subjects before and 1-year after surgery-induced fat loss, and from nonobese controls. In a second similar cohort of obese subjects, adipocytes and stromal-vascular fraction were isolated. Intra-adipose cortisol and cortisone levels were analyzed by liquid chromatography mass spectrometry and HSD11B1/HSD11B2 mRNA by qPCR. RESULTS SAT cortisol/cortisone ratio before fat loss, median 4.8 (interquartile range, 4.1-5.7), was higher than after fat loss, 1.9 (1.0-2.7) (P = 0.001), and compared to nonobese controls, 3.2 (2.4-3.9) (P = 0.005). Cortisone before fat loss, 2.3 (1.2-2.9) nmol/kg, was lower than after fat loss, 5.8 (3.0-10.2) nmol/kg (P = 0.042), and compared to controls, 5.1 (3.8-6.7) nmol/kg (P = 0.013). HSD11B1 was predominantly expressed in mature adipocytes, whereas HSD11B2 was expressed at a higher level in stromal-vascular fraction. CONCLUSIONS The intra-adipose glucocorticoid metabolism was markedly altered in the extremely obese state with increased cortisol levels relative to cortisone, whereas fat loss restored this balance approximating nonobese subjects. Changes were more pronounced for cortisone than cortisol, suggesting an adaptive response to insufficient intra-adipose cortisol levels in obesity.
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Affiliation(s)
- Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway; Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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Våge V, Nilsen RM, Berstad A, Behme J, Sletteskog N, Gåsdal R, Laukeland C, Mellgren G. Predictors for remission of major components of the metabolic syndrome after biliopancreatic diversion with duodenal switch (BPDDS). Obes Surg 2013; 23:80-6. [PMID: 23011463 DOI: 10.1007/s11695-012-0775-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Metabolic surgery causes the remission of type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to varying degrees, depending on the patient characteristics and the surgical procedure. The aim of this study was to find predictors for the remission of T2DM and hypertension after biliopancreatic diversion with duodenal switch (BPDDS). METHODS Eighty patients with T2DM were followed up for 2 years or more after BPDDS, and changes in body weight and metabolic status were noted. Remission was defined as fasting glucose <7 mmol/l with HbA1C <6.5 %, blood pressure <140/90 mmHg, and low-density lipoprotein (LDL) <2.6 mmol without the use of medication. RESULTS Preoperatively, the mean age was 44 years, body mass index (BMI) was 48 kg/m(2), and duration of diabetes was 5 years. Of the 80 patients, 38 patients were using insulin, 48 patients were using antihypertensives, and 38 patients were using a lipid-lowering drug. Five percent of the patients had recommended levels for HbA1C, blood pressure, and LDL prior to the operation. The remission rate at 2 years was 94 % for T2DM, 54 % for hypertension, and 86 % for LDL hyperlipidemia. Preoperative predictors for nonremission of T2DM were a higher BMI, insulin usage, and low insulin C-peptide, and for hypertension, older age and more severe hypertension. Postoperative weight loss was important for both. CONCLUSIONS Surgical intervention with BPDDS is an effective treatment of T2DM, hypertension, and hyperlipidemia. The duration of T2DM and age of the patient are the most important preoperative predictors for the remission of T2DM and hypertension, respectively.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Førde Central Hospital, 6807 Førde, Norway.
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Våge V. Pasienten i sentrum! Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Veum VL, Dankel SN, Gjerde J, Nielsen HJ, Solsvik MH, Haugen C, Christensen BJ, Hoang T, Fadnes DJ, Busch C, Våge V, Sagen JV, Mellgren G. The nuclear receptors NUR77, NURR1 and NOR1 in obesity and during fat loss. Int J Obes (Lond) 2011; 36:1195-202. [PMID: 22143616 DOI: 10.1038/ijo.2011.240] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adipose tissue is critical for systemic metabolic health. Identifying key factors regulating adipose tissue function is a research priority. The NR4A subfamily of nuclear receptors (NRs) (NR4A1/NUR77, NR4A2/NURR1 and NR4A3/NOR1) has emerged as important proteins in different disease states and in the regulation of metabolic tissues, particularly in liver and muscle. However, the expression of the NR4A members in human adipose tissue has not previously been described, and their target genes are largely unknown. OBJECTIVE To determine whether the NR4As are differentially expressed in human adipose tissue in obesity, and identify potential NR4A target genes. DESIGN Prospective analysis of s.c. adipose tissue before and 1 year after fat loss, and during in vitro differentiation of primary human preadipocytes. Case-control comparison of omental (OM) adipose tissue. SUBJECTS A total of 13 extremely obese patients undergoing biliopancreatic diversion with duodenal switch for fat loss, 12 extremely obese patients undergoing laparoscopic sleeve gastrectomy and 37 lean individuals undergoing hernia repair or laparotomy were included in the study. Measurements were done by quantitative PCR gene expression analysis of the NR4A members and in silico promoter analysis based on microarray data. RESULTS There was a strong upregulation of the NR4As in extreme obesity and normalization after fat loss. The NR4As were expressed at the highest level in stromal-vascular fraction compared with adipocytes, but were downregulated in both fractions after fat loss. Their expression levels were also significantly higher in OM compared with s.c. adipocytes in obesity. The NR4As were downregulated during differentiation of primary human preadipocytes. Moreover, the NR4As were strongly induced within 30 min of tissue incubation. Finally, promoter analysis revealed potential NR4A target genes involved in stress response, immune response, development and other functions. Our data show altered adipose tissue expression of the NR4As in obesity, suggesting that these stress responsive nuclear receptors may modulate pathogenic potential in humans.
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Affiliation(s)
- V L Veum
- Institute of Medicine, University of Bergen, Bergen, Norway
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Dankel SN, Fadnes DJ, Stavrum AK, Stansberg C, Holdhus R, Hoang T, Veum VL, Christensen BJ, Våge V, Sagen JV, Steen VM, Mellgren G. Switch from stress response to homeobox transcription factors in adipose tissue after profound fat loss. PLoS One 2010; 5:e11033. [PMID: 20543949 PMCID: PMC2882947 DOI: 10.1371/journal.pone.0011033] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/12/2010] [Indexed: 12/31/2022] Open
Abstract
Background In obesity, impaired adipose tissue function may promote secondary disease through ectopic lipid accumulation and excess release of adipokines, resulting in systemic low-grade inflammation, insulin resistance and organ dysfunction. However, several of the genes regulating adipose tissue function in obesity are yet to be identified. Methodology/Principal Findings In order to identify novel candidate genes that may regulate adipose tissue function, we analyzed global gene expression in abdominal subcutaneous adipose tissue before and one year after bariatric surgery (biliopancreatic diversion with duodenal switch, BPD/DS) (n = 16). Adipose tissue from lean healthy individuals was also analyzed (n = 13). Two different microarray platforms (AB 1700 and Illumina) were used to measure the differential gene expression, and the results were further validated by qPCR. Surgery reduced BMI from 53.3 to 33.1 kg/m2. The majority of differentially expressed genes were down-regulated after profound fat loss, including transcription factors involved in stress response, inflammation, and immune cell function (e.g., FOS, JUN, ETS, C/EBPB, C/EBPD). Interestingly, a distinct set of genes was up-regulated after fat loss, including homeobox transcription factors (IRX3, IRX5, HOXA5, HOXA9, HOXB5, HOXC6, EMX2, PRRX1) and extracellular matrix structural proteins (COL1A1, COL1A2, COL3A1, COL5A1, COL6A3). Conclusions/Significance The data demonstrate a marked switch of transcription factors in adipose tissue after profound fat loss, providing new molecular insight into a dichotomy between stress response and metabolically favorable tissue development. Our findings implicate homeobox transcription factors as important regulators of adipose tissue function.
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Affiliation(s)
- Simon N. Dankel
- Institute of Medicine, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Dag J. Fadnes
- Department of Medicine, Førde Central Hospital, Førde, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kristin Stavrum
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christine Stansberg
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rita Holdhus
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tuyen Hoang
- Institute of Medicine, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Vivian L. Veum
- Institute of Medicine, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Jostein Christensen
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Villy Våge
- Department of Surgery, Førde Central Hospital, Førde, Norway
| | - Jørn V. Sagen
- Institute of Medicine, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Vidar M. Steen
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Institute of Medicine, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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Andersen JR, Aasprang A, Bergsholm P, Sletteskog N, Våge V, Natvig GK. Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch. Health Qual Life Outcomes 2010; 8:52. [PMID: 20492663 PMCID: PMC2881107 DOI: 10.1186/1477-7525-8-52] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms. METHODS Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression. RESULTS The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004). CONCLUSIONS The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.
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Affiliation(s)
- John Roger Andersen
- Faculty of Health Studies, Sogn og Fjordane University College, Box 523, 6803 Førde, Norway.
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Roger Andersen J, Aasprang A, Bergsholm P, Sletteskog N, Våge V, Karin Natvig G. Health-related quality of life and paid work participation after duodenal switch. Obes Surg 2009; 20:340-5. [PMID: 19352783 DOI: 10.1007/s11695-009-9837-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Morbid obesity can reduce the health-related quality of life (HRQL) and paid work participation, and the duodenal switch (DS) can induce large weight loss in patients suffering from this disease. However, data about HRQL combined with paid work participation after duodenal switch are lacking. The aim of this study was to provide longitudinal data of these issues. METHODS Fifty-one consecutive morbidly obese patients accepted for DS gave their informed consent to participate in the study. Mean age was 37.7 years (SD, 8.0), and 54.9% were women. HRQL was assessed using the "Short-Form 36 Health Status Survey". Eight subscores, the physical component summary (PCS), and the mental component summary (MCS) were calculated. Paid-work participation was assessed as performing or not performing paid work. Data were assessed before DS (T0), 1 year after DS (T1), and 2 years after DS (T2). RESULTS All the SF-36 scores improved significantly from T0 to T1 and T2 (p < 0.001), when they were in the normal range compared to the population norm. The number of patients performing paid work increased from 28 (54.9%) at T0 to 34 (66.7%) at T2, p = 0.031. The patients who performed paid work had significantly better PCS and MCS scores than those who did not before, but not after, DS. CONCLUSION Our data indicate that the SF-36 scores of the patients were normalized after DS. A marked improvement in the paid work participation was also observed.
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Affiliation(s)
- John Roger Andersen
- Faculty of Health Studies, Sogn and Fjordane University College, Box 523, 6803, Førde, Norway.
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Aasprang A, Andersen JR, Sletteskog N, Våge V, Bergsholm P, Natvig GK. [Health-related quality of life before and one year after operation for morbid obesity]. Tidsskr Nor Laegeforen 2008; 128:559-562. [PMID: 18311198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Several studies have shown that morbid obese patients have poor health-related quality of life. The aim of this study was to investigate the effect of bariatric surgery (biliopancreatic diversion with duodenal switch) on health-related quality of life for morbidly obese patients. METHODS 48 patients (26 women and 22 men, mean age 37.4, mean BMI 51.5) completed the Short Form 36 (SF-36) before and one year after surgery. Paired t-tests were used to analyze differences in SF-36 scores before and one year after surgery. RESULTS Morbidly obese patients had very poor health-related quality of life (SF-36) before surgery compared with norms (p < 0.001). One year after surgery, all SF-36 dimensions had improved significantly (p < 0.001). CONCLUSIONS The morbidly obese patients in this study had very poor health-related quality of life compared to norms, but they experienced considerable improvement after bariatric surgery.
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Affiliation(s)
- Anny Aasprang
- Avdeling for helsefag Høgskulen i Sogn og Fjordane Postboks 523 6803 Førde.
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Mundal L, Ignjatovic D, Våge V, Asmussen I, Sund S. [A woman with hemorrhagic shock]. Tidsskr Nor Laegeforen 2005; 125:1833-4. [PMID: 16025570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action. MATERIAL AND METHODS We present an 82-year-old female patient with haematemesis, who during the first few minutes after admission developed haemorrhagic shock. At emergency laparotomy, a profuse bleeding in the duodenum was found. During surgery the patient developed cardiovascular collapse and died. The patient had a previous diagnosis of duodenal ulcer. She was, furthermore, diagnosed with an abdominal aortic aneurysm developing at the cranial anastomosis of an aorto-bifemoral bypass performed seventeen years earlier. An autopsy was performed and confirmed the clinical suspicion of an aorto-duodenal fistula. RESULTS AND INTERPRETATION An aorto-enteric fistula represents a direct communication between the aorta and the intestinal lumen; it can be primary or secondary. Secondary aorto-enteric fistulae are complications of reconstructive procedures on the abdominal aorta. Based on register data, approximately three patients with this condition could be expected per year in Norway (incidence 1.6 %). Patients with severe gastric-intestinal bleeding and previous aortic reconstruction represent an identifiable group that should be referred directly to hospitals with competence in vascular surgery.
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Affiliation(s)
- Liv Mundal
- Medisinsk avdeling, Førde sentralsjukehus, 6807 Førde.
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Abstract
OBJECTIVE Jejunoileal (JI) bypass was a widely performed surgical procedure for morbid obesity in the 1970s. The purpose of this study was to assess cardiovascular risk factors and mortality in patients 25 years or more after this operation. MATERIAL AND METHODS All (n = 36) patients operated on for obesity with JI bypass at Haukeland University Hospital between 1971 and 1976 were evaluated. Survivors (n = 28) participated in a follow-up that included clinical examination and biochemical tests. Preoperative data were compared with data at 1 year (3 years) and 25 years. Causes of death were identified for the deceased. RESULTS For the 23 patients alive with intact JI shunts at 25 years there was a statistically significant lowering of body mass index (BMI) (p < 0.01), systolic blood pressure (p < 0.05), diastolic blood pressure (p < 0.001) and serum cholesterol (p < 0.05) compared to before the operation. There was no statistically significant change in fasting blood glucose or serum triglyceride. The serum insulin level was normal in all but one (21/22) of the patients examined. Three out of 26 patients with intact JI shunts, and 5 out of 10 patients with reversed JI shunts, had died. CONCLUSION For patients with intact shunts there is a persistent reduction in body weight, serum cholesterol and blood pressure, and a reduced insulin resistance 25 years after JI bypass.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Ferde Central Hospital, Ferde, Norway.
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Abstract
BACKGROUND Jejunoileal (JI) bypass was a widely performed operation for morbid obesity in the 1970s. The aim of this study was to investigate the long-term status of bone mineral density (BMD) after weight loss induced by this technique. SUBJECTS AND METHODS 18 female patients (age 48-79 y, BMI 23-43 kg/m2) had BMD measurements performed 25 years after JI bypass. Dual energy x-ray absorptiometry was used, and measured sites were the lumbar spine L2-L4, left femoral neck and total hip. Vitamin and mineral supplementation had not routinely been prescribed. An assessment was made on age-adjusted BMD values, and as to whether present BMD was related to present demographic and biochemical variables. RESULTS No significant reduction of BMD was found beyond that which was expected for age. BMD was inversely and separately related to age and body weight. The serum level of vitamin D was low in 45% of the patients, and inversely correlated to body weight and BMI. Alk phosphatase and parathyroid hormone were the best markers for low BMD. CONCLUSION These results suggest that JI bypass has not been detrimental to bone density in females. We recommend, however, vitamin D and calcium supplements after malabsorptive procedures for morbid obesity.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Central Hospital Førde, N-6807 Førde, Norway.
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Våge V, Solhaug JH, Viste A, Bergsholm P, Wahl AK. Anxiety, Depression and Health-Related Quality of Life after Jejunoileal Bypass: A 25-Year Follow-up Study of 20 Female Patients. Obes Surg 2003; 13:706-13. [PMID: 14627464 DOI: 10.1381/096089203322509264] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Jejunoileal (JI) bypass was a widely performed operation for morbid obesity in the 1970s. The aim of this study was to investigate the long-term status for mental and physical health after weight loss induced by this operation. METHODS 20 female patients (age 48-80 y, BMI 23-75 kg/m2) were interviewed 25 years after JI bypass. The Hospital Anxiety and Depression Scale (HAD) and Short Form 36 (SF-36) were used. Scores from the Norwegian female population, and published scores for morbidly obese patients were used for comparison. An assessment was made on whether present demographic and clinical factors influenced the scores. RESULTS Anxiety and depression scores, and scores for physical functioning, bodily pain, vitality and mental health on the SF-36 were similar to scores in the Norwegian female population used for comparison. The scores from the patient sample were much better than scores published for morbidly obese patients, and implies that weight loss induced by the operation has been of great benefit on mental health and health-related quality of life. Anxiety and depression symptoms improved; however, being socially handicapped by the stools had a negative impact on HAD and SF-36 scores. CONCLUSION These results suggest that 25 years after the JI bypass most of these patients have a similar level of mental and physical health as the general Norwegian female population. For individuals with bothersome side-effect(s) of the operation, a negative impact is seen.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Central Hospital, Førde, Norway.
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37
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Abstract
BACKGROUND Induction of intestinal malabsorption by jejunoileal (JI) bypass was a widely performed procedure for morbid obesity in the 1970's. The purpose of this study was to evaluate the long-term results. METHODS A total of 36 patients underwent JI bypass from November 1971 to September 1976. At operation the median age was 33 years and median BMI 42 kg/m2. Shunt lengths varied between 45 and 60 cm. The present check-up of the 28 patients still alive included clinical examination, biochemical tests, bone density measurement and measurement of fecal fat excretion. RESULTS 10 patients (28%) had had their shunt reversed. With one exception these patients quickly regained weight, and 5 (50%) of them were dead. 23 patients with an intact JI shunt are alive, but 5 of them have had the shunt shortened due to weight gain. Their median age today is 56 years, and median BMI is 30. None of these patients were known to have coronary heart disease or diabetes mellitus at follow-up. Malabsorption of fat is still present. Blind loop syndrome, flatulence, foul fecal smell and diarrhea are the most troublesome long-term sequelae. Vitamin and mineral deficiencies are common. 2 of 21 patients (age 80 and 57 years) have osteoporosis. CONCLUSION When the optimal shunt length for the individual patient is found, JI bypass maintains a substantially reduced weight for 25 years. Vitamin and mineral deficiencies are common, but no serious clinical deficiency states are seen.
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Affiliation(s)
- Villy Våge
- Department of Surgery, Deacon Hospital, Oslo, Norway.
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38
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Vang T, Våge V, Sletteskog N. [Boerhaave's syndrome--an unusual cause of acute retrosternal pain]. Tidsskr Nor Laegeforen 2002; 122:603-4. [PMID: 11998712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Boerhaave's syndrome or spontaneous perforation of the oesophagus is a rare condition with a severe prognosis. Adequate treatment is often delayed because of misdiagnosis of the condition as cardial, pulmonary or other gastrointestinal disease, with a concomitant rise in mortality. MATERIAL AND METHODS A case of Boerhaave's syndrome is described. An 88-year-old male presented with acute retrosternal pain, initially believed to be caused by cardiac disease. After a delay of more than 24 hours, laparotomy revealed a perforation of the oesophagus. RESULTS The patient was treated with laparotomy, drainage, antibiotics, antifungal and medical supportive therapy. Surgical closure of the lesion was not performed because of the debilitated state of the patient and the delay in diagnosis. He left the hospital in his habitual state after 33 days of hospitalization. INTERPRETATION Boerhaave's syndrome is a serious condition that is often misdiagnosed. The preferred treatment is prompt surgical closure of the oesophageal defect.
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Affiliation(s)
- Torkel Vang
- Kirurgisk avdeling Sentralsjukehuset i Sogn og Fjordane 6800 Førde.
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39
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Schrøder Hansen K, Våge V, Morild I. Vertical shear forces and their influence on disruption of the diaphragm and thoracic aorta. Eur J Surg 2001; 167:548-51. [PMID: 11560394 DOI: 10.1080/110241501316914966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- K Schrøder Hansen
- Emergency Department, Haukeland University Hospital, Bergen, Norway.
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40
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Hjetland R, Søgnen E, Våge V. [Erysipelothrix rhusiopathiae--a cause of erysipeloid and endocarditis]. Tidsskr Nor Laegeforen 1995; 115:2780-2. [PMID: 7570494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Erysipelothrix rhusiopathiae is widespread among many species of animals including fish. Erysipeloid is the most common infection caused by this bacterium in man; systemic infection, with endocarditis, is rare. Most of the affected patients risk exposure to the organism at work. Two patients with E. rhusiopathiae infections are described; one with erysipeloid after slaughtering a deer, the other with fatal endocarditis after gutting an eel. Erysipeloid may be confused with "seal finger", but this disease probably has a different microbial etiology and requires different antibiotic treatment.
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Affiliation(s)
- R Hjetland
- Mikrobiologisk avdeling, Sentralsjukehuset i Sogn og Fjordane, Førde
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