Resolution of Diabetes Mellitus and Metabolic Syndrome following Roux-en-Y Gastric Bypass and a Variant of Biliopancreatic Diversion in Patients with Morbid Obesity

Alexandrides, Theodore K.; Skroubis, George; Kalfarentzos, Fotis

doi:10.1007/s11695-007-9044-z

Cited by 77 publications

(51 citation statements)

References 41 publications

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“…The novelty of the current report is the observation of a beneficial effect of biliopancreatic diversion of serum aminotransferase levels that is maintained up to 4 years after surgery. Other short-term studies (2 years of follow-up) with biliopancreatic diversion have been shown beneficial effects on liver enzymes similar to the findings of our study [20,21]. Furthermore, analysis of the relation between changes in transaminases levels and changes in body weight showed a positive correlation with increasing weight loss at 4 years follow-up.…”

Section: Discussionsupporting

confidence: 90%

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up

Aller

Pacheco²,

Izaola³

et al. 2015

Ann Nutr Metab

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Background: Elevated serum aminotransferase levels are commonly associated with obesity and with a progression to chronic liver disease. Bariatric surgery is the most effective strategy to achieve weight loss. Methods: We conducted the present study with the aim of evaluating the influence of biliopancreatic diversion (BPD) on liver enzymes levels during 4 years in morbid obese patients with normal aminotransferase (n = 65) and in morbid obese patients with high aminotransferase basal levels (n = 50). Results: A decrease in alanine aminotransferase and aspartate aminotransferase activities was significant after biliopancreatic diversion. The basal percentage of high aminotransferase levels and percentage of ratio ALT/AST <1 also decreased significantly at 1-, 2-, 3- and 4-years of follow-up in both groups. ALT (52 to 20%), AST (42 to 10%) and ALT/AST (80 to 22%) in patients with normal aminotransferase. ALT (82 to 20%), AST (70 to 6%) and ALT/AST (90 to 20%) in patients with elevated transaminase basal levels. Bariatric surgery was associated with a significant and sustained decrease in body weight in both groups. Serum trasnaminases level changes were positively correlated to body weight changes during follow-up. Conclusion: BPD is an effective method of achieving sustainable weight loss and reduced aminotransferase levels and enzyme ratios of liver damage.

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Section: Discussionsupporting

confidence: 90%

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up

Aller

Pacheco²,

Izaola³

et al. 2015

Ann Nutr Metab

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“…However, nutrient deficiencies can occur [26] due to many mechanisms, for example the type of surgery [27][28] . Proper monitoring of nutritional status and additional supplementation, as needed, can aid in preventing severe clinical and biochemical deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results and Nutritional Consequences of Biliopancreatic Diversion: Three Years of Follow-Up

et al. 2008

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Background: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The aim of our work was to describe clinical results and nutritional complications in morbidly obese patients with biliopancreatic diversion. Methods: We have analyzed a consecutive series of 64 patients who have been followed up for 3 years after undergoing open biliopancreatic diversion by the Scopinaro technique. Results: Initial excess weight loss was 29.3% at 6 months and 61.5% at 3 years. A significant improvement of body mass index, weight, waist circumference, fat mass, glucose level, total cholesterol, uric acid and triglycerides levels was detected. Ferritin, vitamin A, vitamin D, vitamin B₁₂, zinc and copper levels showed a low percentage of deficiency at basal time, but during the follow-up, the percentage of deficiency increased. Vitamin E and K did not show basal deficiency. However, after surgery, a moderate deficiency of both vitamins was detected (vitamin E 7.1% and vitamin K 8.3%). Folic acid deficiency was observed in 54.3% of the subjects at basal time, but decreased during the study. Conclusion: Biliopancreatic diversion is an effective method of sustainable weight loss. However, micronutrient deficiencies can occur.

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“…With incidence of morbid obesity on the rise, gastric bypass surgery has become more common, not just for weight loss but also for treatment of associated comorbidities, especially type 2 diabetes mellitus. To date, there have been numerous studies looking at amelioration and remission of diabetes after gastric bypass, with remission rates in excess of 80% reported [2][3][4][5]. Several explanations for the improvement in glucose regulation and insulin resistance after gastric bypass surgery have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia

et al. 2010

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Abnormal GTT is a common finding post RYGB. Persistence of diabetes was noted in 50% of patients with diabetes preoperatively. Amongst the nondiabetic patients, reactive hypoglycemia was found to be more common and pronounced than expected. Absence of abnormally high insulin levels does not support nesidioblastosis as an etiology of this hypoglycemia. More than 50% of patients with reactive hypoglycemia had significantly exaggerated MMGR. We believe this may be due to the nonphysiologic transit of food to the small intestine due to lack of a pyloric valve after RYGB. This reactive hypoglycemia may contribute to maladaptive eating behaviors leading to weight regain long term. Our data suggest that GTT is an important part of post-RYGB follow-up and should be incorporated into the routine postoperative screening protocol. Further studies on the impact of pylorus preservation are necessary.

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Resolution of Diabetes Mellitus and Metabolic Syndrome following Roux-en-Y Gastric Bypass and a Variant of Biliopancreatic Diversion in Patients with Morbid Obesity

Cited by 77 publications

References 41 publications

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up

Clinical Results and Nutritional Consequences of Biliopancreatic Diversion: Three Years of Follow-Up

Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia

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