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

I report the general experience of performing sleeve gastrectomy defined as "a partial gastrectomy that results in removal of most of the stomach," as a first-stage procedure for morbidly and super-obese people. I also explore its potential as a single procedure evaluating its advantages and disadvantages. This procedure is designed to reduce the size of the stomach and its distention, whereby the patient feels full sooner and their appetite is decreased. Some posit-increased satiety results from the decreased ghrelin, secreted by the fundus, which is resected during this procedure. The advantages of sleeve gastrectomy are as follows: the stomach is reduced without loss of function, pyloric preservation prevents dumping, it requires only 1 day in the hospital, it provides an effective first-stage procedure for super-obese patients, it is useful in patients with disorders such as anemia or Crohn's disease, which preclude intestinal bypass, it can be performed laparoscopically, even in patients who weigh over 500 lbs, no band adjustment is required, it does not result in malabsorption, and it provides a good educational teaching base for doctors lacking experience in the treatment of gastric ulcers. The disadvantages include the risk of stapling complications and its irreversibility.
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PMID:Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? 1856 Sep 78

Patients with anorexia nervosa (AN) may develop multiple endocrine abnormalities, including amenorrhea, hyperactivity of the hypothalamus-pituitary-adrenal axis, hypothyroidism and particular changes in the activity of the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis. Exaggerated GH secretion and reduced IGF-I levels are usually found in AN, as well as in conditions of malnutrition and malabsorption, insulin-dependent diabetes mellitus, liver cirrhosis and catabolic states. In AN, GH hypersecretion at least partially reflects malnutrition-induced peripheral GH resistance, which leads to reduced IGF-I synthesis and release; this implies an impairment of the negative IGF-I feedback action on GH secretion. On the other hand, primary alterations in the neural control of GH secretion cannot be ruled out. The neuroendocrine alterations include enhanced somatotroph responsiveness to growth hormone releasing hormone (GHRH) and impaired GH response to most central nervous system-mediated stimuli. Particular resistance to cholinergic manipulation has also been demonstrated, thus suggesting a somewhat specific alteration in the somatostatin (SS)-mediated cholinergic influence on GH secretion. Moreover, paradoxical GH responses to glucose load, thyrotropin releasing hormone (TRH) and luteinizing hormone releasing hormone (LHRH) have also been reported. The effect of reduced leptin levels on GH hypersecretion in AN is still unclear, but ghrelin (the gastric hormone that is a natural ligand of the GH secretagogue receptor and strongly stimulates somatotroph secretion) is thought to play a major role. Regardless of the supposed central and peripheral alterations, it has to be emphasised that the activity of the GH/IGF-I axis in AN is generally restored by nutritional and stable weight gain. It therefore reflects an impaired nutritional state and cannot be considered a primary hallmark of the disease.
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PMID:GH/IGF-I axis in anorexia nervosa. 1764 63

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

A consequence of gastrectomy is loss of bone mass. Several mechanisms have been proposed, such as malabsorption of vitamins and minerals. Additionally, a peptide hormone produced in the stomach has been shown to mediate a calcitropic effect on bone. The identity of this peptide has not been elucidated, but ghrelin, produced by A-like cells in the fundus of the stomach, could be a good candidate. Ghrelin stimulates growth hormone (GH) secretion both in vivo and in vitro, and could by this means have a positive effect on bone. There is also evidence for direct effects of ghrelin on bone. We discuss here the role that ghrelin may play in bone metabolism, based on the most recent literature.
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PMID:Ghrelin and bone. 1798 59

Celiac disease (CD) is a chronic immune-mediated gluten-dependent enteropathy induced by ingestion of gluten-containing products, characterized by intestinal malabsorption and subtotal or total atrophy of intestinal villi, which improves after gluten-free diet (GFD). Untreated patients affected by the classic form of CD are at high risk of malnutrition, but an impairment of nutritional status is frequently reported also in patients with the subclinical form of the disease. Strict adherence to a GFD greatly improves nutritional status, inducing an increase in fat and bone compartments, but does not completely normalize body composition. A lack of improvement in nutritional status may identify incomplete adherence to GFD treatment. Evidence has shown lower body weights and lower fat mass and fat-free mass contents in CD patients. Untreated CD patients oxidize more carbohydrates as energy substrate compared to treated subjects. In addition, circulating ghrelin concentration was reduced after GFD treatment as a possible consequence of body composition improvement, while leptin did not correlate with the changes in body composition and substrate oxidation in patients with CD. A significant correlation was reported between ghrelin and the degree of severity of intestinal mucosal lesions. CD patients might show an alteration in lipid metabolism, i.e. low serum total and high- density lipoprotein-cholesterol as a consequence of lipid malabsorption and decreased intake. In conclusion, weight loss and nutritional deficiencies are relevant clinical features in CD. Thus, an early and accurate evaluation of nutritional status and energy metabolism represents a fundamental tool in the management of CD patients.
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PMID:Metabolic and nutritional features in adult celiac patients. 1843 Oct 62

Coeliac disease (CD) is a genetically determined gluten-sensitive enteropathy resulting in nutrient malabsorption, with an increasing incidence world-wide. Clinical presentation in early childhood may include classic malabsorption symptoms, whereas older CD children often present extra-intestinal symptoms including short stature and pubertal delay. A gluten-free diet (GFD) generally leads to a rapid catch-up in growth and to normalization of the pituitary function. The pathogenesis of CD-associated short stature is still unclear. Besides the involvement of the growth hormone (GH)/insulin-like growth factor-I axis, a role for ghrelin was recently proposed. Furthermore, some CD patients do not show catch-up growth during GFD, despite reversion to seronegativity for CD markers including antiendomysial and anti-tissue transglutaminase antibodies. These subjects show GH deficiency and could potentially benefit from recombinant human GH therapy. This review deals with the management of short stature and the evaluation of growth axis function in CD children.
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PMID:Short stature in children with coeliac disease. 1955 Mar 80

Lifestyle modifications and pharmacologic therapy have been the mainstays of treatment for patients with type 2 diabetes mellitus. Bariatric surgery, originally designed as a weight loss treatment, has been proven to ameliorate and even cure diabetes. The significant improvement in glycemic control found after bariatric surgery in patients with diabetes often precedes major weight loss. Therefore, a weight-independent mechanism has been thought to initiate this amelioration in glucose control. Reviews of the recent literature question the goal of bariatric surgery, not only to treat obesity through restriction and malabsorption, but also as a possible treatment for diabetes regardless of the degree of obesity. Procedures such as Roux-en-Y gastric bypass, adjustable gastric banding, and biliopancreatic diversion have proven to be extremely effective in controlling diabetes mellitus. Mechanisms explaining the effectiveness of weight reduction surgery include effects on incretins, ghrelin secretion, and insulin sensitivity. Some centers have been performing gastric bypass surgeries on patients with a lower body mass index than that recommended by current NIH guidelines. New considerations for recommending bypass surgery are warranted as the indications for antiobesity surgeries grow to encompass both the treatment and cure of diabetes.
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PMID:Surgical approaches for the prevention and treatment of type 2 diabetes mellitus. 1982 76

Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgery in which 60% to 80% of the stomach is removed longitudinally, resulting in a smaller stomach that takes the shape of a "sleeve." The mechanism for weight loss is gastric restriction and possible neurohormonal changes resulting from lower levels of ghrelin (an appetite-stimulating hormone), as a consequence of removing the gastric fundus. LSG may be more desirable than laparoscopic adjustable gastric banding because there is no foreign object inside the abdomen and no need for postsurgery appointments to adjust the band. LSG may be preferred over Roux-en-Y gastric bypass (RYGB) because LSG is a less complicated operation that does not result in dumping syndrome or malabsorption, yet weight loss is comparable to RYGB. While LSG is suggested to have advantages over the commonly performed laparoscopic adjustable gastric banding and RYGB, there are no long-term (>5 years) outcomes and few studies specific to nutrition care for LSG patients. This article will present a protocol for pre- and postsurgery nutrition care for LSG and the important role the registered dietitian plays in the multidisciplinary team. Postsurgery diet progression from liquids to solids during 6 to 8 weeks should focus on meeting protein and fluid needs. In addition, LSG patients are at risk for nutrient deficiencies due to decreased hydrochloric acid and intrinsic factor from removed parietal cells and reduced dietary intake due to decreased ghrelin levels. Therefore, LSG patients should take daily micronutrient supplements, including vitamin B-12 and potentially supplemental iron, to prevent deficiencies.
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PMID:Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. 2033 86

Ghrelin and leptin are newly discovered, still very mysterious, hormones. Beside the energy balance, they regulate endocrine and immune system, growth and maturate processes. Fluctuations of both hormones concentration are observed in many gastrointestinal tract diseases. In this publication is presented current knowledge about meaning ghrelin and leptin in choosen diseases, like malabsorption syndromes, inflammatory diseases and tumors of gastrointestinal tract.
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PMID:[Meaning of ghrelin and leptin in gastrointestinal tract diseases]. 2036 31

Weight loss treatments include diets, drugs, physical training, and surgery, namely bariatric or obesity surgery. The current standard for bariatric surgery is gastric bypass. There are common beliefs that gastric bypass induces body weight loss because of a reduced food intake and that high-fat diet induces overweight and obesity because of overnutrition. The principal aim of the studies on rats summarized herein was to better understand the physiological mechanisms by which gastric bypass achieves body weight loss and by which high-fat diet induces obesity. The results indicated that gastric bypass efficiently reduced body weight, particularly the fat compartment, which was unlikely to be caused by early satiety, reduced food intake or malabsorption, and that large meal size, but not overnutrition, was mainly responsible for high-fat diet-induced obesity. It was unclear whether gastric ghrelin, obestatin and/or amine in the A-like cells were involved in this context.
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PMID:Feeding behavior and body weight development: lessons from rats subjected to gastric bypass surgery or high-fat diet. 2038 43


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