-Context -Causal factors of gastrojejunal ulcers after Roux-en-Y gastric bypass include peptic acid secretion from the gastric pouch. Esomeprazole is a potent inhibitor of acid secretion. Objective -To assess the occurrence of dyspepsia and gastrojejunal ulcers within the first 2 months after Roux-en-Y gastric bypass during the use of esomeprazole. Methods -One hundred eighteen morbid obese subjects were submitted to Roux-en-Y gastric bypass. Preoperative upper gastrointestinal tract endoscopy was negative for H. pylori. All subjects received esomeprazole for 60 days after surgery. Results -Two weeks after surgery only 13 mild symptoms were reported. After 2 months, 17 also moderate complaints were registered. Endoscopy around the 60th day showed esophagitis in 10 (8.5%), hiatal hernia in 2 (1.7%), foreign body in the anastomotic line in 12 (10.2%) and gastrojejunal ulcers was observed in 9 (7.6%) subjects, 2 of which had a suture material or metallic staple granuloma in the gastrojejunostomy. Ten subjects took nonsteroidal anti-inflammatory drugs at least once during study, but none of them developed ulcer. None of the subjects with ulcer had dyspeptic symptoms. Conclusion -The incidence of ulcer in the gastrojejunal anastomosis within the first 2 months following Rouxen-Y gastric bypass under proton pump inhibitors is considerable. It was not related to the use of non-steroidal anti-inflammatory drugs, highlighting the possibility of ischemia and foreign body as causal factors. The ulcers were asymptomatic, and all post-surgical dyspeptic symptoms were moderate in severity.

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Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects Relação do ácido úrico com os componentes da síndrome metabólica antes e após o bypass gástrico com reconstrução em Y-de-Roux em pacientes obesos mórbidos , p = 0,0002). Homens com hiperuricemia foram mais propensos a ter diabetes (p = 0,034) e tinham níveis mais elevados de glicemia de jejum (p = 0,027). Mulheres com hiperuricemia foram mais propensas a ter hipertensão arterial (p = 0,003), síndrome metabólica (p = 0,001), triglicérides elevado (p = 0,001) e GGT (p = 0,009) e diminuição de HDL (p = 0,011). Após a cirurgia, os níveis de ácido úrico diminuíram de 5,60 ± 1,28 para 4,23 ± 1,20 (p < 0,0001). A prevalência de hiperuricemia diminuiu 33,6% para 6,4% (p < 0,0001), em homens de 48,3% para 17,2% (p < 0,0001) e nas mulheres de 29,7% para 3,6% (p < 0,0001). Conclusão: As concentrações de ácido úrico foram associadas com a prevalência de anormalidades metabólicas nesta amostra de pacientes com obesidade mórbida. Além disso, a perda de peso após RYGBP pode reduzir os níveis de ácido úrico e a prevalência de hiperuricemia. Arq Bras Endocrinol Metab. 2011;55(1):38-45Descritores Ácido úrico; síndrome metabólica; cirurgia bariátrica

Background Metabolic Syndrome (MS) is a complex disorder characterized by a number of cardiovascular risk factors usually associated with central fat deposition and insulin resistance. Nowadays, there are many different medical treatments to MS, including bariatric surgery, which improves all risk factors. The present study aims to evaluate the influence of gastric bypass in the improvement of risk factors associated with MS, during the postoperative (6 months). Methods This was a retrospective study of 140 patients submitted to gastric bypass. The sample was comprised of a female majority (79.3 %). The mean body mass index (BMI) was 44.17 kg/m 2 . We evaluated the weight of the subjects, the presence of diabetes mellitus and hypertension as comorbidities, as well as plasma levels of triglycerides (TG), total cholesterol and its fractions, and glycemia, in both preoperative and postoperative. Results The percentage of excess weight loss (%EWL) was similar in men and women, with an average of 67.82± 13.21%. Concerning impaired fasting glucose (≥100 mg/dl), 41 patients (95.3%) presented normal postoperative glycemia.There has been an improvement of every appraised parameter. The mean decrease in TG level was 66.33 mg/dl (p<0.0001). Before the surgery, 47.1% were hypertensive; after it, only 15% continued in antihypertensive drug therapy (p<0.0001). Otherwise, the only dissimilar variable between sexes was the high-density lipoprotein (HDL) level. Conclusion Gastric bypass is an effective method to improve the risk factors of metabolic syndrome in the morbidly obese.

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Objectives: To evaluate whether biochemical parameters are associated with a good glycemic control and to identify the occurrence of cardiometabolic risk variables. Material and methods: One hundred forty Brazilians were evaluated. The subjects were characterized with regard to glycemic control as good, fair and poor and were divided into tertiles by TG and HbA 1c . We use the ROC curve to determine which variables were predicted of poor glycemic control and the factor analyses to identify the domains that segregated among the risk variables. Results: Fasting glucose and insulin levels, TG level, VLDL-C and HOMA-IR increased significantly across HbA 1c tertiles. The best marker for identification of poor glycemic control was triglycerides. The presence of cardiometabolic abnormalities did not alter the glycemic control, but HOMA-IR was significantly higher in subjects with abnormalities. Conclusion: The use of TG levels offers a reasonable degree of clinical utility. In morbidly obese subjects insulin resistance is associated with individual cardiometabolic factors.

Of the equations studied, those of Sobh and Salazar-Corcoran seem to be the best for estimating the glomerular filtration rate in severely obese patients analyzed in our study.

Elevated levels of liver markers, principally GGT, in morbidly obese subjects are associated with metabolic abnormalities. In addition to the well-known benefits of bariatric surgery, Roux-en-Y gastric bypass, reduced the levels of liver markers to the normal range.