Cirurgia metabólica: mudanças na anatomia gastrointestinal e a remissão do diabetes mellitus tipo 2

Abstract

DESCRITORES -Cirurgia bariátrica.Obesidade mórbida. Diabetes mellitus. Derivação gástrica.RESUMO -Introdução -O diabetes mellitus tipo 2 (DMT2) é uma das maiores causas de morte no mundo devido a sua relação direta com as doenças cardiovasculares. Apesar dos avanços da terapêutica, a maioria dos pacientes nunca atinge os objetivos terapêuticos necessários para prevenção de suas complicações. A cirurgia metabólica abre um campo para novas perspectivas no controle desta doença. Objetivos -Descrever o tratamento cirúrgico de pacientes portadores de diabetes mellitus tipo 2, e os resultados encontrados após os procedimentos, além de discutir os mecanismos das alterações metabólicas encontradas no pós-operatório destes pacientes. ABSTRACT -Introduction -Type 2 diabetes mellitus ( T2DM), is the major cause of mortality worldwide, mainly secondary to cardiovascular events. In spite of the recent advances in the medical treatment, an expressive number of patients remain uncontrolled. Metabolic surgery may open new frontiers to control this devastating disease. Aim -To describe the surgical alternatives to treat surgically T2DM patients, including some proposed mechanisms of action that are behind the metabolic improvement. Methods -PubMed and Lilacs database were searched according to the following keywords: bariatric surgery, morbid obesity, diabetes mellitus, gastric bypass. Results -Some conventional procedures over the gastrointestinal tract have an important effect on T2DM control, without a direct effect of weight loss. Some studies report that rearranging the gastrointestinal tract anatomy is the key factor that lead to that beneficial metabolic effect of surgery. All bariatric operations lead to T2DM improvement, but with distinct mechanisms underlying that effect. Conclusion -There is a trend to stimulate research in this new exciting field. Randomized controlled trials are demanded, comparing surgical versus the best medical treatment of T2DM. After those results, the exact role of gastrointestinal tract surgery will be defined and its benefit over medical treatment as well. INTRODUÇÃOO diabetes mellitus tipo 2 (DMT2) é uma das maiores causas de morte no mundo devido à sua relação direta com as doenças cardiovasculares, cerebrovasculares e insuficiência renal. Além disso, é responsável por um grande número de complicações como a cegueira, as amputações, a disfunção erétil, a diarréia e a gastroparesia8. O tratamento clínico para essa doença avançou consideravelmente, mas continua deixando a maioria dos pacientes susceptíveis às suas graves complicações.

Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery

“…Cohen et al 5 , studying 86 patients with a BMI of 22 to 34 kg/m 2 submitted to duodenojejunal bypass, observed long-term remission of T2DM in 78% of the patients, but no significant increase in GLP-1. These results suggest that the surgical procedure performed in the present study promotes intestinal alterations that differ from those induced by duodenojejunal bypass, increasing fasting GLP-1 concentration and thus contributing to the improvement of T2DM.…”

O efeito em curto prazo do bypass gástrico sobre pacientes obesos diabéticos

“…Mottin et al demonstrated control of T2DM in 97.6% of patients 18 months after gastric bypass 4 . We found that some authors use the term resolution, while others use control and others remission 24 .…”

Obesos diabéticos tipo 2 submetidos à derivação gástrica em Y-de-Roux: análise de resultados e influência nas complicações

“…Prolonged remission was defined as more than five years without medication. Such criteria, which have been cited in a number of studies, have been updated by the American Diabetes Association 3,7,11,16 .…”