An Alarmingly High Number of Candidates for Bariatric Procedures among Professionally Active Poles and Its Strong Relationship with Cardiovascular Co-Morbidities-POL-O-CARIA 2022 Study

Over recent years, the global healthcare system has experienced a notable increase in the prevalence of obesity and its associated health complications such as hypertension, type 2 diabetes, lipid disorders, etc. What is more, one of the significant phenomena is the increasing demand for bariatric procedures among individuals of working age due to the high prevalence of type III obesity and type II obesity with co-morbidities. This trend is pronounced in Poland, due to the increasing number of patients meeting the qualifying criteria for surgery among professionally active and inactive patients. The aim of this study is to characterize the alarmingly high number of candidates for bariatric procedures among professionally active Poles. In total, the results of 2,056,861 initial, control, and periodic visits as part of the occupational medicine certificate were analyzed-collected from 1,342,749 unique patients (51.7% men; mean age of whole group: 36.81, SD = 10.91). Statistical calculations were performed, qualitative data were assessed using percentage and occurrence counts, while qualitative data were described using mean (M), standard deviation (SD), median, skewness, kurtosis, and range values. Results with p < 0.05 were deemed significant. Chi-square analysis and one-way ANOVA (with Scheffe's post hoc test) were employed. Charts were created in the R program. It was noticed that there was a consistent rise in the proportion of individuals classified as candidates for bariatric procedures (an increase of 0.3%) alongside a notable decrease in the percentage of individuals maintaining a healthy body weight. Moreover, it is imperative to conduct yearly evaluations of the prevalence of obesity and its associated health conditions. It should be noted that hypertension occurred in 42.2% of patients, type 2 diabetes in 6.2% of patients, and lipid disorders in 8.4% of patients with third-degree obesity. This proactive approach is essential in order to adequately equip the healthcare system to address the increasing population of obese individuals, especially candidates for bariatric procedures.

The prevalence of, and risk factors for, Barrett's oesophagus after sleeve gastrectomy

Introduction

Sleeve gastrectomy has become one of the most performed bariatric procedures. There is increasing evidence that sleeve gastrectomy patients suffer from gastroesophageal reflux disease and its sequelae such as erosive oesophagitis (EO) or Barret’s oesophagus (BO).

Aim

To evaluate the incidence of EO and BO among patients with normal preoperative oesophagogastroduodenoscopy findings, who underwent sleeve gastrectomy, and investigate factors that may contribute to the development of EO and BO after the surgery.

Material and methods

We conducted a single-centre longitudinal study that included patients who underwent sleeve gastrectomy and completed 5 years of follow-up. Gastroscopies were performed in all patients at the end of the follow-up period. Patient- and treatment-related factors were used to search for risk factors of BO.

Results

From a total of 30 patients, symptomatic reflux was reported by 17 (56.7%) during the follow-up period. At EGD EO was found in 9 of those patients (30%), whereas BE was diagnosed in 8 (27%) patients. The median BMI at the end of the follow-up period was significantly higher among patients with BE than in the groups with EO and with no endoscopic changes: 40.91 ±6.32, 32.42 ±5.53, and 33.25 ±4.41, respectively (p = 0.04).

Conclusions

The prevalence of BO in SG patients is considerable. The risk of BE increases in patients with poor bariatric outcome. Endoscopic surveillance should be considered as part of the follow-up, especially in patients with higher overall risk of BE.

[Psychological assessment of candidates for bariatric surgery]

Nowadays, the number of bariatric surgery for treating morbid obesity is significant. There is strong evidence about the influence of mental state (depression, anxiety, eating disorder, etc.) on patient's cooperation with the medical team and the outcome, and on the short or long-term effectiveness of surgery. However, no protocol or recommendation exist for screening patients before bariatric procedures in Hungary. Thus, even if the surgeon or the hospital requires psychological expertise, neither doctors are familiar with the expectable results of such an expertise, nor psychologists know exactly what the most important areas are to talk through with patients. This article shortly reviews the mostly used bariatric surgery procedures and presents a protocol that was developed by the Ochsner Clinic, New Orleans in detail. Based on the protocol, the core parts of the psychological interview are the following: reasons for seeking surgery (I.), weight and diet history (II.), current eating behaviors (III.), understanding of the surgery and its associated lifestyle changes (IV.), social supports (V.), and history and psychiatric symptoms (current and past) (VI.). The original protocol was completed with newer, more recent studies, statements, and with examples by the authors. Orv Hetil. 2019; 160(12): 448-455.

How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?

Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery. Beside the standard proximal Roux-en-Y gastric bypass and the biliopancreatic diversion with or without duodenal switch, where parts of the small intestine are excluded from contact with nutrients, resectional techniques like the sleeve gastrectomy (SG) have recently been added to the armory of bariatric surgeons. The variation of weight loss and glycemic control is vast between but also within different bariatric operations. We surveyed members of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders to assess the extent to which the phenotype of patients influences the choice of bariatric procedure. Swiss bariatric surgeons preferred Roux-en-Y gastric bypass and SG for patients with type 2 diabetes mellitus and patients with a body mass index >50 kg/m², which is consistent with the literature. An SG was preferred in patients with a high anesthetic risk or previous laparotomy. The surgeons’ own experience was a major determinant as there is little evidence in the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice.

[Invasive methods in the treatment of obesity]

Treatment of obesity and concomitant diseases have a significant burden on the health care system. Due to the lack of efficacy of conservative treatment methods, attention has shifted towards invasive methods. Surgical and endoscopic treatments of obesity are based on two different methods: restrictive and malabsorptive procedures or their combination. The author reviews the most effective surgical and endoscopic procedures in the treatment of obesity.

Critical analysis of bariatric procedures in Prader-Willi syndrome

Prader-Willi syndrome (PWS) is a complex genetic disorder localized to chromosome 15 and is considered the most common genetic cause of the development of life-threatening obesity. Although some morbidities associated with PWS, including respiratory disturbance/hypoventilation, diabetes, and stroke, are commonly seen in obesity, others such as osteoporosis, growth hormone deficiency, and hypogonadism, and also altered pain threshold and inability to vomit, pose unique issues. Various bariatric procedures have been used to cause gastric stasis, decrease gastric volume, and induce malabsorption, with poor results in PWS patients in comparison with normal obese individuals.