Beribéri pós bypass gástrico: uma complicação não tão rara. Relato de dois casos e revisão da literatura

Abstract

RESUMOÉ crescente o número de pacientes submetidos à cirurgia bariátrica para tratamento da obesidade mórbida; devido a isso, estão reaparecendo deficiências nutricionais com as quais muitos médicos já não estão familiarizados. No pós-operatório, podem ocorrer vários distúrbios nutricionais, sendo um deles a deficiência de tiamina (beribéri). A deficiência de tiamina e/ou vitamina B12 pode corresponder a 40% dos casos de neuropatia após a cirurgia bariátrica. Serão descritos dois pacientes com a clínica de neuropatia periférica e síndrome de Wernicke-Korsakoff. Alguns meses após a cirurgia, eles apresentaram prostração, depressão, confusão mental e nistagmo, associados a dor e parestesia dos membros (principalmente inferiores). Com a hipótese diagnóstica de beribéri, foi iniciado o tratamento com tiamina. Um dos pacientes apresentou melhora completa do quadro neurológico, porém o outro permaneceu com déficit motor, sendo aquele em que decorreu o maior tempo entre o aparecimento dos sintomas e o início do tratamento. Estes casos servem para nos alertar sobre a importância da vigilância nutricional após a cirurgia bariátrica. The number of patients submitted to bariatric surgery to treat morbid obesity is increasing, therefore, some nutritional deficiencies, with which many physicians are no longer familiarized, are reappearing. Postoperatively, many nutritional disorders may occur, one of them is thiamine deficiency (beriberi). The thiamine and/or vitamin B12 deficiency can correspond to 40% of the neuropathy cases after bariatric surgery. Two patients with the clinic of peripheral neuropathy and Wernicke-Korsakoff syndrome will be reported. Some months after the surgery, they presented prostration, depression, mental confusion and nystagmus, associated with pain and paresthesia in limbs (especially lower limbs). With the diagnostic hypothesis of beriberi, the treatment with thiamine started. One of the patients presented complete improvement of the neurological symptoms, however the other one remained with motor deficiency, exactly the one who spent a longer period of time between the symptoms appearance and the treatment beginning. These cases serve to alert us about the importance of nutritional vigilance after bariatric surgery. (Arq Bras Endocrinol Metab 2006;50/3:564-568)

Aspectos nutricionais em obesos antes e após a cirurgia bariátrica

“…Os distúrbios nutricionais vão desde carências vitamínico-minerais (ferro, zinco, tiamina, niacina, ácido fólico, cobalamina, vitaminas A, D e E) até manifestações de desnutrição energético-protéica 14,15 . Os possíveis mecanismos são: ingestão nutricional deficiente, má absorção decorrente da técnica cirúrgica, pobre aderência à reposição de polivitamínicos e a presença de sintomas gastrintestinais 16 . Considerando as repercussões da cirurgia bariátrica em obesos mórbidos, o objetivo deste estudo foi avaliar as características clínico-nutricionais desses pacientes, no pré e pós-operatório, assim como a presença de intolerâncias alimentares e sintomas comuns neste contexto.…”

Study of the clinical and histopathological repercussions of the "omental band" in dogs' stomach

“…Patients with morbid obesity require one efficient approach to promote loose of weight, once that is a condition that put in risk the life of the patient whereas turns worse its quality of life and self-worth 1 . Today, the bariatric surgery is an option to people with morbid obesity that come showing efficient results with effective loose of weight.…”

“…Today, the bariatric surgery is an option to people with morbid obesity that come showing efficient results with effective loose of weight. The ant obesity surgeries can be divided in restrictive procedures (that limit the gastric capacity), bad absorptive (that interfere in the digestion) and one combination of both techniques 1 . In this way, the bariatric surgery constitutes a mix technique that rests the size of the gastric cavity (and, consequently, the quantity of ingested aliments) and reduces the intestinal surface in contact with the aliment (dysabsorption.…”

Need for Multivitamin Use in the Postoperative Period of Gastric Bypass

“…Currently, the most variable degrees of medium-and long-term nutritional deficiencies are observed in these patients. This is the greatest concern of the healthcare professionals involved in this treatment [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…Nutritional deficiencies and alterations most often determined by laboratory tests during the first year after surgery are: hypoalbuminemia, deficiencies in iron, folic acid, and vitamin B12, and anemia [7,9,12,14,15,[17][18][19][20][21].…”