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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Biliopancreatic diversion (BPD) for morbid obesity carries a serious risk of nutritional deficiencies that might impair embryogenesis. Consequently, attention should be given to the potential of risk to the fetus of BPD in women of childbearing age. We present the case of a pregnant woman who had undergone BPD 8 years previously, with documented vitamin A deficiency, who gave birth to a child with bilateral microphthalmia. Infectious and genetic causes of microphthalmia were excluded. A search of the literature revealed that vitamin A deficiency may cause a disruption of ocular development. We conclude that nutritional deficiencies may cause a spectrum of fetal malformations. As the effect of BPD relies on malabsorption, fetal risk should be considered before BPD is offered to morbid obese women of childbearing age.
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PMID:Maternal vitamin A deficiency and neonatal microphthalmia: complications of biliopancreatic diversion? 1671 78

The rapid increase of morbid obesity has become an important task in the Western world in recent years. Since conservative treatments have failed to prove sufficient efficacy, surgery has turned out to be the most powerful option in treating morbid obesity. In this paper, the different surgical techniques with their advantages and drawbacks are presented. In general, there are restrictive, malabsorptive and combinations of both procedures available. The adjustable gastric banding (Figure 1) represents a purely restrictive operation. It is useful for patients with a relatively low body mass index (BMI) and a good understanding and control of their eating habits. By contrast, the duodenal switch (Figure 2) stands for a mainly malabsorptive procedure that might be indicated in patients with a very high BMI. The Roux-en-Y gastric bypass (Figure 3) is the most widely used bariatric procedure worldwide. It combines restriction and malabsorption. Today, almost two thirds of all bariatric procedures are performed laparoscopically, which has further enhanced the use of surgery in the treatment of morbid obesity. In conclusion, the treatment of morbid obesity represents a significant challenge in the Western world, and bariatric surgery plays a paramount role in the fight against overweight.
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PMID:[Benefits and risks of bariatric surgery]. 1677 May 60

The rising prevalence of morbid obesity and the increased incidence of super-obese patients (BMI >50 kg/m2) seeking surgical treatments has led to the search for surgical techniques that provide adequate EWL with the least possible morbidity. Sleeve gastrectomy (SG) was initially added as a modification to the biliopancreatic diversion (BPD) and then combined with a duodenal switch (DS) in 1988. It was first performed laparoscopically in 1999 as part of a DS and subsequently done alone as a staged procedure in 2000. With the revelation that patients experienced weight loss after SG, interest in using this procedure as a bridge to more definitive surgical treatment has risen. Benefits of SG include the low rate of complications, the avoidance of foreign material, the maintenance of normal gastro-intestinal continuity, the absence of malabsorption and the ability to convert to multiple other operations. Reduction of the ghrelin-producing stomach mass may account for its superiority to other gastric restrictive procedures. SG should be in the armamentarium of all bariatric surgeons. Nonetheless, long-term studies are necessary to see if it is a durable procedure in the treatment of morbid obesity.
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PMID:Sleeve gastrectomy for morbid obesity. 1789 58

The objective of the present study was to identify the factors which contribute to the appearance and/or aggravation of Vitamin A Deficiency (VAD) in individuals with morbid obesity in the pre- and postoperative stages of Roux-en-Y gastric bypass (RYGBP). Bibliography searches were done in the data-bases of Medline and Lilacs, published in the last 35 years, priorizing the studies which assessed VAD through serum levels of retinol. The principal factors identified as contributors to VAD were oxidative stress, deficiency of other nutrients, lipid malabsorption in the postoperative stage, insufficient intake of lipids and food sources of Vitamin A, and presence of nonalcoholic fatty liver disease. The investigation of the nutritional status of Vitamin A in those individuals may foment intervention strategies easily incorporated in already established routine procedures, aiming to reduce VAD rates, which will reflect upon those individuals' quality of life.
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PMID:Nutritional status of vitamin A in morbid obesity before and after Roux-en-Y gastric bypass. 1789 59

The prevalence of obesity and the number of surgeries for morbid obesity are increasing worldwide. Conservative therapy is largely ineffective in producing maintenance of weight loss in morbidly obese patients, and surgery is therefore increasingly considered as the only available option for these patients. Until approximately 15 years ago, many patients and physicians regarded bariatric surgery as dangerous because it required a large laparotomy and was associated with a relatively high risk of complications. Since laparoscopic techniques have become available, however, the number of patients referred for surgery has been increasing steadily. The principles of standard procedures are independent of access, whether open or laparoscopic. The pathophysiologic mechanisms are restriction, malabsorption, or a combination of both. New findings in the field of endocrine and humoral regulations have shown that surgical procedures can induce complex changes in the regulation of enterohormones. These mechanisms are the basis for metabolic effects, especially in cases of diabetes mellitus type 2. Obesity surgery is known to be the most effective and longest-lasting treatment for morbid obesity and many related conditions, but mounting evidence now suggests that it may also be among the most effective treatments for metabolic diseases and conditions such as type 2 diabetes, hypertension, high cholesterol, nonalcoholic fatty liver disease, and obstructive sleep apnea. Surgery for severe obesity goes far beyond weight loss; benefits include improved quality of life and extended life expectancy.
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PMID:[Obesity - principles of surgical therapy]. 1875 40

Morbid obesity is a significant problem in the Western world. Recently, there has been an increase in the number of patients undergoing surgical weight loss procedures. Currently, the most widely performed procedure is the Roux-en-Y gastric bypass operation which combines restriction of food intake with malabsorption of calories and various nutrients, resulting in weight loss and nutritional deficiencies, respectively. Various types of anemia may complicate Roux-en-Y and commonly include deficiencies of iron, folate, and vitamin B12. Iron deficiency is particularly common and may result from many mechanisms including poor intake, malabsorption, and mucosal bleeding from marginal ulceration. However, less appreciated etiologies of nutritional anemia include deficiencies of B-complex vitamins, ascorbic acid, and copper. Replacement of the missing or decreased constituent usually reverses the anemia. Since physicians of various medical and surgical specialties are often involved with the postoperative care of bariatric patients, a review of anemia in this patient population is warranted.
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PMID:Anemia following Roux-en-Y surgery for morbid obesity: a review. 1879 27

Obesity is a problem that is reaching epidemic proportions throughout the world and bariatric surgery is now a rapidly growing technique. However existence of obesity in humans has been recognized for thousands of years, as statues dating from the Stone Age period appear to provide the earliest depictions. Hippocrates (466-355 b.C.) and Galen (131-201 a.C.) had a clear understanding of the condition, its consequences and medical treatment. On the other hand bariatric surgery was a xx century treatment, but at the end of the xix century it was known that the massive loss of small bowel or gastric resection after ulcer surgery resulted in persistent weight loss. Malabsorption and gastric restriction in isolation, or more commonly in combination, remain the main options to surgical control of weight. Unfortunately surgery as a non etiological treatment is an imperfect model to treat an incurable disease: morbid obesity. Prevention and better knowledge of disease would allow a tailored medical or surgical approach.
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PMID:[Obesity in the history of surgery]. 1937

Bariatric surgery is the most effective treatment for morbid obesity. Although calorie malabsorption does not occur in most bariatric procedures, micronutrient deficiencies are possible. Multivitamin supplementation is essential following bariatric surgery. The recommendation would be to screen for multivitamin deficiencies prior to surgery and to monitor vitamin levels postoperatively at regular intervals. In this paper, we review the data for screening and supplementation after bariatric procedures for different vitamins.
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PMID:After bariatric surgery, what vitamins should be measured and what supplements should be given? 1950 88

WHO has listed obesity as a disease condition in its International Classification of Disease since 1979 and has assigned obesity a specific ICD-9, clinical modification code of #278.00, and morbid obesity, code #278.01. About 95% of those conservatively treated for morbid obesity will remain at the same weight or even gain weight during 5 years of follow-up. In 1991 an NIH Consensus Conference Panel convened and recommended that morbidly obese patients be offered an operative treatment for their disease. The weight loss mechanism of the bariatric operations is not clear, but the presumed effects are gastric restriction of food intake, malabsorption of the nutrients achieved by intestinal bypass, and secretion of different neuropeptides, that cause depression of the appetite and change in the metabolic rate. Restrictive operations are considered simpler and safer in terms of surgical performance and short term risks, but their efficacy is inferior to the malabsorptive ones. The latter are larger in regard to surgical extent, may cause more metabolic derangements, but produce more solid and long-lasting weight loss. The operation should be tailored to the candidate taking into consideration sex, age, health-related conditions, medications that are being taken, eating habits, and risks and benefits of every specific procedure. It is advisable that a bariatric surgery candidate undergo a thorough preoperative evaluation by a multidisciplinary team including a surgeon, a dietician, a psychology specialist, an internist or an endocrinologist, and other subspecialties as needed. A bariatric patient should maintain a life-long follow-up.
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PMID:[Surgical treatment of morbid obesity]. 1926 8

Roux-en-Y gastric bypass is a gastric reduction duodenal switch with a combination of restrictive and malabsorptive procedures. It is the most common gastric bypass procedure performed in the United States. Malabsorption causing nutritional deficiencies does occur, yet a PubMed literature search (1955-2009) returned no reports of malabsorption of anticancer agents after gastric bypass. To our knowledge, this is the first report of three cases of malabsorption of the anticancer agent tamoxifen after this procedure. The first patient was a 58-year-old woman who underwent Roux-en-Y bypass for morbid obesity. Two years later, she developed estrogen receptor-positive ductal carcinoma in situ of the breast, underwent lumpectomy and irradiation, and tamoxifen was started. Two years after that, she presented with concerns of potential malabsorption of the drug. Her plasma tamoxifen level was 28 ng/ml, which was below the lower limit of the therapeutic range (77-274 ng/ml for 10-30-mg/day regimens). The second patient was a 51-year-old woman who sought medical advice on risk reduction for breast cancer after receiving a diagnosis of atypical ductal hyperplasia of the breast. She also had a history of morbid obesity and underwent Roux-en-Y bypass. Tamoxifen was started to reduce her risk of breast cancer; her plasma tamoxifen level was subtherapeutic at 14 ng/ml. The third patient was a 53-year-old woman with estrogen receptor-positive breast cancer who underwent lumpectomy and was prescribed anastrozole, an aromatase inhibitor. She also underwent Roux-en-Y bypass for morbid obesity. As she experienced adverse effects while receiving anastrozole, the drug was discontinued, and tamoxifen 20 mg/day was started. Her tamoxifen plasma level was 52 ng/ml. Therefore, her tamoxifen dosage was increased to 20 mg twice/day. Six weeks later, her tamoxifen level was 120 ng/ml (therapeutic range 95-520 ng/ml for the increased dosage). These three cases suggest that steady-state serum tamoxifen levels should be evaluated in patients who have undergone Roux-en-Y gastric bypass. Until adequate data suggest otherwise, parenteral anticancer alternatives should be considered when systemic therapy is needed in a patient with malabsorption.
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PMID:Tamoxifen malabsorption after Roux-en-Y gastric bypass surgery: case series and review of the literature. 2009 95


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