The overall intestinal lipopolysaccharide (LPS) composition in the individuals with obesity could be shifted away from immunosilent/immunoinhibitory
Bacteroidetes
LPS subtypes, in favor of various proinflammatory LPS subtypes due to gut microbiome dysbiosis. What is more, high-fat diet, as well as obesity per se, enhance intestinal permeability through various mechanisms. Latter results in increased paracellular absorption and transcellular (via chylomicrons) transport of endogenous endotoxin in the circulatory system (endotoxemia). In addition, it is known that lipid A initiates a signaling cascade resulting in activation of various proinflammatory pathways and increases oxidative stress upon binding to tool-like receptor 4 (TLR4). Taking everything into consideration, it is very likely that gut microbiome dysbiosis and endotoxemia represent the additional pathophysiological explanation for increased COVID-19 severity in obesity.
Summary
The aim of the present manuscript is to discuss on potential pros and cons of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) as glucose‐lowering agents during COVID‐19 pandemic, and what is more to evaluate them as potential candidates for the treatment of patients, affected by COVID‐19 infection, with or even without diabetes mellitus type 2. Besides being important glucose‐lowering agents, GLP‐1RAs pose promising anti‐inflammatory and anti‐obesogenic properties, pulmonary protective effects, as well as beneficial impact on gut microbiome composition. Hence, taking everything previously mentioned into consideration, GLP‐1RAs seem to be potential candidates for the treatment of patients, affected by COVID‐19 infection, with or even without type 2 diabetes mellitus, as well as excellent antidiabetic (glucose‐lowering) agents during COVID‐19 pandemic times.
Background: Conventional approaches in the management of obesity offer only a limited potential for sustained weight loss. Moreover, bariatric surgery, although momentarily being the most effective weight-loss treatment, has some serious pitfalls, such as significant morbidity rate, high substantial costs and limited patient applicability. Hence, there is a substantial need for endoscopic approaches to obesity. Summary: The aim of this article is to provide a historical overview of bariatric endoscopy in the management of obesity; moreover to selectively review and evaluate the currently available endoscopic weight-loss techniques and devices, and third to identify new directions and future prospects in this rapidly advancing field. Key Messages: Bariatric endoscopy procedures efficiently replicate some of the anatomical features and the physiological effects of the traditional weight-loss surgical approaches, while at the same time being more applicable, entirely reversible, less-invasive, safer and more cost effective. Endoscopic modalities in the treatment of obesity can be categorized into the following: restrictive procedures, malabsorptive procedures, gastric function/emptying regulation, gastric aspiration, and so on. To conclude, it is of high importance to constantly evaluate the long-term efficacy and safety of new endoscopic weight-loss techniques and devices, based on evidence-based medicine principles.
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