Severe BN may be considered as a latent and potentially malignant MO. BPD (or BPD/DS) may be an effective solution for some patients with severe BN, as a final decision after unsuccessful organized conservative attempts. All candidates for bariatric surgery should be screened for BN, because it may influence choice of procedure in favor to BPD or BPD/DS.
We examined 292 patients (mean age 37,5±9,1 years) with morbid obesity (initial BMI 47,3±7,0 kg/m2), from which 72 patients had type 2 diabetes, before and after biliopancreatic diversion in Hess-Marceau modification, conducted from 2003 to 2010. Along with a significant and steady weight loss, the most important advantage of surgery is its high efficiency in treatment of disturbances in carbohydrate and lipid metabolism in patients with morbid obesity and associated type 2 diabetes and severe atherogenic dyslipidemia.
Aim. To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity.
Materials and methods. We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared.
Results. In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed.
Conclusion. Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.
A clinical significance in the treatment of bulimia nervosa patients with morbid obesity had already been raised [10, 13], but we did not find publications on the effectiveness of bariatric surgery in these cases. There is also information about the possibility of applying the operation bilio-pancreatic bypass, effective in patients with morbid obesity with uncontrolled eating behavior for the treatment of patients with anorexia BILIM not suffering from morbid obesity. In this article the data of clinical observation of a small sample of patients. As a result, the treatment of these patients found that severe nervous BILIM can be seen as a latent form of morbid obesity. The choice of treatment should depend not only on the initial body weight of the patient, but also on the severity of the nervous BILIM. Unsuccessful attempts at organized-balanced, conservative treatment of patients with severe bulimia nervosa may be considered a variant of surgical treatment, while bilio-pancreatic bypass surgery is considered as the most preferred operation, compared with the installation of the gastric balloon and others. All candidates for surgical treatment of obesity must identify clinical signs of bulimia nervosa, as this may influence the choice of method of operation. Further study of the role of hyperinsulinemia, secretion of ghrelin, leptin, intestinal peptide may contribute to the elucidation of the true causes of bulimia nervosa, probably has a similar origin with morbid obesity.
Obesity is one of the most urgent problems of modern medicine. This is - one of the most common chronic diseases in the world, was characterized by WHO as "non-infectious epidemic of the late XX - early XXI century." According to data presented at the Consensus Conference of the National Institutes of Health and the American Society of Bariatric Surgeons in 2004, as well as the WHO European Conference on Obesity in 2006, 1.7 billion people on the planet, including 2/3 of the US population are overweight (MT), with one in five adults and one in seven teen - morbid obesity, ie, has a body mass index greater than 40 kg / m2. More than 700 000 deaths in the United States, and 1 million in Europe each year can be attributed to obesity, and in the structure of mortality in 13% of Europeans reasons anyway associated with obesity. Life expectancy at morbid obesity is reduced by 9 years for women and 12 years for men. According to forecasts of epidemiologists, 2025 will double the number of patients suffering from obesity.
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