Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is highly prevalent in many developed and developing countries and is on the increase. The range of obese patients suitable for endoscopic treatment may be very broad. The most widely applied treatment in Spain and elsewhere in Europe is the Allergan intragastric balloon. The effectiveness of this technique is good in the short-term but suboptimal in the long term and its safety profile is high. However, severe complications may occur and consequently the indication and implantation of this technique should not be trivialized. In addition, there are distinct endoscopic devices that help patients lose weight, through distinct mechanisms of action, but these devices are currently under technological development and awaiting scientific validation. It is too soon to recommend these techniques and they should only be evaluated in the context of clinical trials.
 ...
PMID:[Endoscopic treatment of obesity]. 2313 74

Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan. Non-pharmacological interventions both for mental disorders and overweight/obesity must be fully availed.
...
PMID:Weight considerations in psychotropic drug prescribing and switching. 2411 70

A 49-year-old female (weight 81 kg, height 161 cm, BMI 31.2) presented at the emergency department complaining of 2-day history of worsening cramp-like abdominal pain and vomiting. She had not passed stools or flatus in the last 36 h and reported to have had an intra-gastric balloon (BioEnterics Intra-gastric Balloon, Allergan. Inc, Irvine, Calif) inserted 9 months earlier to treat grade I obesity. The balloon was introduced during an upper endoscopy at another institution in Latin America, and she denied having any follow-up since moving to Europe. While in the E.R., an abdominal x-ray and abdominal triple contrast CT scan (with oral water-soluble contrast) showed a complete small-bowel obstruction caused by the distal migration of a foreign body. This was consistent with the intra-gastric balloon impacted in the distal jejunum. Free fluid was also evident. Emergency surgery was mandatory, and a laparoscopic approach was chosen. After identification of the cecum and ileocecal valve, the small intestine was carefully inspected starting from the distal ileum by "run-the-bowel", proximally. An evident transition point between collapsed and distended bowel loops was identified, and a clear bulging of the bowel wall caused by the deflated and impacted balloon was observed at the site. A transverse enterotomy 3.5 cm in length was performed with laparoscopic scissors, distally to the obstruction site. The balloon was gently pulled out, taking care not to tear or damage the bowel and once removed was placed within an endobag. Laparoscopic enterorrhaphy was performed with double-layer intra-corporeal suture. The postoperative course was uneventful.
 ...
PMID:Complete small-bowel obstruction from a migrated intra-gastric balloon: emergency laparoscopy for retrieval via enterotomy and intra-corporeal repair. 2477 61