Signs Symptoms & Treatment Stomach Ulcers

Signs Symptoms & Treatment Stomach Ulcers

Amplify’d from www.betterhealth.vic.gov.au

Summary A stomach ulcer (peptic ulcer) is a break in the tissue lining the stomach. Most are caused by infection with the Helicobacter pylori bacterium. Symptoms may include abdominal pain just below the ribcage, indigestion, nausea, loss of appetite, vomiting, weight loss, blood in the vomit or bowel motions and symptoms of anaemia, such as light-headedness. Treatment options include antibiotics and acid-suppressing medications.

Summary A stomach ulcer (peptic ulcer) is a break in the tissue lining the stomach. Most are caused by infection with the Helicobacter pylori bacterium. Symptoms may include abdominal pain just below the ribcage, indigestion, nausea, loss of appetite, vomiting, weight loss, blood in the vomit or bowel motions and symptoms of anaemia, such as light-headedness. Treatment options include antibiotics and acid-suppressing medications. Share this article Email this article Add link to social media Facebook, Myspace, Twitter Download this article PDF text & pictures for sharing & saving A stomach or gastric ulcer is a break in the tissue lining the stomach. The term 'peptic ulcer' refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of st

A stomach or gastric ulcer is a break in the tissue lining the stomach. The term 'peptic ulcer' refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion. Treatment for stomach ulcers includes the use of antibiotics to kill the infection, and acid-suppressing drugs. Symptoms of stomach ulcers Some stomach ulcers don’t produce any symptoms. If present, they can include:

The stomach

The stomach is an organ of the digestive system, located in the abdomen just below the ribs and on the left. Swallowed food is squeezed down the oesophagus and pushed through a sphincter (small muscle ring) into the stomach, where it is mixed with powerful gastric juices containing enzymes and hydrochloric acid. The stomach is a muscular bag, so it can churn the food and break it down mechanically as well as chemically.

Causes of stomach ulcers

A stomach ulcer can be caused by a variety of factors, including: Helicobacter pylori – bacteria is thought to be responsible for around 60 per cent of stomach ulcers and at least 90 per cent of duodenal ulcers. Certain medications – which include aspirin or clopidogrel, taken regularly to help prevent heart attack or stroke, and drugs for arthritis. Anti-inflammatory medications (NSAIDS) are thought to cause around two fifths of stomach ulcers.

Helicobacter pylori

Summary A stomach ulcer (peptic ulcer) is a break in the tissue lining the stomach. Most are caused by infection with the Helicobacter pylori bacterium. Symptoms may include abdominal pain just below the ribcage, indigestion, nausea, loss of appetite, vomiting, weight loss, blood in the vomit or bowel motions and symptoms of anaemia, such as light-headedness. Treatment options include antibiotics and acid-suppressing medications. Share this article Email this article Add link to social media Facebook, Myspace, Twitter Download this article PDF text & pictures for sharing & saving A stomach or gastric ulcer is a break in the tissue lining the stomach. The term 'peptic ulcer' refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion. Treatment for stomach ulcers includes the use of antibiotics to kill the infection, and acid-suppressing drugs. Symptoms of stomach ulcers Some stomach ulcers don’t produce any symptoms. If present, they can include: Abdominal pain just below the ribcage Indigestion Nausea Loss of appetite Vomiting Weight loss Bright or altered blood present in vomit or bowel motions Symptoms of anaemia, such as light-headedness Shock due to blood loss – a medical emergency. The stomach The stomach is an organ of the digestive system, located in the abdomen just below the ribs and on the left. Swallowed food is squeezed down the oesophagus and pushed through a sphincter (small muscle ring) into the stomach, where it is mixed with powerful gastric juices containing enzymes and hydrochloric acid. The stomach is a muscular bag, so it can churn the food and break it down mechanically as well as chemically. Once the food is the consistency of smooth paste, it is squeezed through a second sphincter into the first part of the small intestine (duodenum). The lining of the stomach – the mucosa or gastric epithelium – is layered with multiple folds. Ulcers occur in this lining. Causes of stomach ulcers A stomach ulcer can be caused by a variety of factors, including: Helicobacter pylori – bacteria is thought to be responsible for around 60 per cent of stomach ulcers and at least 90 per cent of duodenal ulcers. Certain medications – which include aspirin or clopidogrel, taken regularly to help prevent heart attack or stroke, and drugs for arthritis. Anti-inflammatory medications (NSAIDS) are thought to cause around two fifths of stomach ulcers. Cancer – stomach cancer can present as an ulcer, particularly in older people. Helicobacter pylori The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers.

It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion). Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations. Ulcer bleeding This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication. Perforated ulcer A severe, untreated ulcer can sometimes burn through the wall of the stomach, allowing digestive juices and food to leak into the abdominal cavity. This medical emergency is known as a perforated ulcer. Treatment generally requires immediate surgery.

Summary A stomach ulcer (peptic ulcer) is a break in the tissue lining the stomach. Most are caused by infection with the Helicobacter pylori bacterium. Symptoms may include abdominal pain just below the ribcage, indigestion, nausea, loss of appetite, vomiting, weight loss, blood in the vomit or bowel motions and symptoms of anaemia, such as light-headedness. Treatment options include antibiotics and acid-suppressing medications. Share this article Email this article Add link to social media Facebook, Myspace, Twitter Download this article PDF text & pictures for sharing & saving A stomach or gastric ulcer is a break in the tissue lining the stomach. The term 'peptic ulcer' refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion. Treatment for stomach ulcers includes the use of antibiotics to kill the infection, and acid-suppressing drugs. Symptoms of stomach ulcers Some stomach ulcers don’t produce any symptoms. If present, they can include: Abdominal pain just below the ribcage Indigestion Nausea Loss of appetite Vomiting Weight loss Bright or altered blood present in vomit or bowel motions Symptoms of anaemia, such as light-headedness Shock due to blood loss – a medical emergency. The stomach The stomach is an organ of the digestive system, located in the abdomen just below the ribs and on the left. Swallowed food is squeezed down the oesophagus and pushed through a sphincter (small muscle ring) into the stomach, where it is mixed with powerful gastric juices containing enzymes and hydrochloric acid. The stomach is a muscular bag, so it can churn the food and break it down mechanically as well as chemically. Once the food is the consistency of smooth paste, it is squeezed through a second sphincter into the first part of the small intestine (duodenum). The lining of the stomach – the mucosa or gastric epithelium – is layered with multiple folds. Ulcers occur in this lining. Causes of stomach ulcers A stomach ulcer can be caused by a variety of factors, including: Helicobacter pylori – bacteria is thought to be responsible for around 60 per cent of stomach ulcers and at least 90 per cent of duodenal ulcers. Certain medications – which include aspirin or clopidogrel, taken regularly to help prevent heart attack or stroke, and drugs for arthritis. Anti-inflammatory medications (NSAIDS) are thought to cause around two fifths of stomach ulcers. Cancer – stomach cancer can present as an ulcer, particularly in older people. Helicobacter pylori The Helicobacter pylori bacterium (H. pylori) is the main cause of peptic ulcers. The discovery of this micro-organism in 1983 revolutionised many aspects of gastroenterology, including the treatment of stomach ulcers. It is thought that about one in three people over the age of 40 years is infected with this strain of bacteria in Australia. The germs live in the lining of the stomach and the chemicals they produce cause irritation and inflammation. H. pylori directly causes one third of stomach ulcers and is a contributing factor in around three fifths of cases. Other disorders caused by this infection include inflammation of the stomach (gastritis) and dyspepsia (indigestion). Researchers believe the germ could also play a contributing role in the development of stomach cancers. The infection is more common among poor or institutionalised people. The mode of transmission is so far unknown, but is thought to include sharing food or utensils, coming into contact with infected vomit, and sharing of water (such as well water) in undeveloped populations. Ulcer bleeding This is a serious complication of ulcer disease and is particularly deadly in the elderly or those with multiple medical problems. Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication. Perforated ulcer A severe, untreated ulcer can sometimes burn through the wall of the stomach, allowing digestive juices and food to leak into the abdominal cavity. This medical emergency is known as a perforated ulcer. Treatment generally requires immediate surgery. Diagnosis of a stomach ulcer Diagnosing a stomach ulcer is done using a range of methods, including: Endoscopy – a thin flexible tube is threaded down the oesophagus into the stomach under light anaesthesia. The endoscope is fitted with a small camera so the physician can see if there is an ulcer. Barium meal – a chalky liquid is drunk and an x-ray is performed, showing the stomach lining. These tests are less common nowadays, but may be useful where endoscopy is unavailable. Biopsy – a small tissue sample is taken during an endoscopy and tested in a laboratory. This biopsy should always be done if a gastric ulcer is found. C14 breath test – to check for the presence of H. pylori. The bacteria convert urea into carbon dioxide. The test involves swallowing an amount of radioactive carbon (C14) and testing the air exhaled from the lungs. A non-radioactive test can be used for children and pregnant women. Treatment for a stomach ulcer Special diets are now known to have very little impact on the prevention or treatment of stomach ulcers. Treatment options can include: Medications – including antibiotics, to destroy the H. pylori colony, and drugs to help speed the healing process. Different drugs need to be used in combination; some of the side effects can include diarrhoea and rashes. Resistance to some of these antibiotics is becoming more common. Subsequent breath tests – used to make sure the H. pylori infection has been treated successfully. Changes to existing medications – the doses of arthritis medications, aspirin or other anti-inflammatory drugs can be altered slightly to reduce their contributing effects on the stomach ulcer. Reducing acid – tablets are available to reduce the acid content in the gastric juices. Lifestyle modifications – this would include quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process. Read more at www.betterhealth.vic.gov.au

 

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Big New Sleeve Study; Not as Bad as the Band Not as Dangerous as the RNY

Big New Sleeve Study; Not as Bad as the Band Not as Dangerous as the RNY

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Ann Surg. 2011 Sep;254(3):410-422. First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass. Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, Nguyen NT. Source *Department of Surgery, Massachusetts General Hospital. Boston, MA †Department of Surgery, University of Virginia Health System. Charlottesville, VA ‡Department of Surgery, Beth Israel Deaconess Medical Center. Boston, MA §Department of Surgery, University of California, Los Angeles Medical Center. Los Angeles, CA ¶American College of Surgeons, Chicago, IL **Department of Surgery, University of Colorado Hospital. Aurora, CO ††Department of Surgery, University of California, Irvine School of Medicine. Irvine, CA; and On behalf of the ACS-BSCN Advisory Committee. Abstract OBJECTIVE: To assess the safety and effectiveness of the laparoscopic sleeve gastrectomy (LSG) as compared to the laparoscopic adjustable gastric band (LAGB), the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the open Roux-en-Y gastric bypass (ORYGB) for the treatment of obesity and obesity-related diseases. BACKGROUND: LSG is a newer procedure being done with increasing frequency. However, limited data are currently available comparing LSG to the other established procedures. We present the first prospective, multiinstitutional, nationwide, clinically rich, bariatric-specific data comparing sleeve gastrectomy to the adjustable gastric band, and the gastric bypass. METHODS: This is the initial report analyzing data from the American College of Surgeons-Bariatric Surgery Center Network accreditation program, and its prospective, longitudinal, data collection system based on standardized definitions and collected by trained data reviewers. Univariate and multivariate analyses compare 30-day, 6-month, and 1-year outcomes including morbidity and mortality, readmissions, and reoperations as well as reduction in body mass index (BMI) and weight-related comorbidities. RESULTS: One hundred nine hospitals submitted data for 28,616 patients, from July, 2007 to September, 2010. The LSG has higher risk-adjusted morbidity, readmission and reoperation/intervention rates compared to the LAGB, but lower reoperation/intervention rates compared to the LRYGB and ORYGB. There were no differences in mortality. Reduction in BMI and most of the weight-related comorbidities after the LSG also lies between those of the LAGB and the LRYGB/ORYGB. CONCLUSION: LSG has morbidity and effectiveness positioned between the LAGB and the LRYGB/ORYGB for data up to 1 year. As obesity is a lifelong disease, longer term comparative effectiveness data are most critical, and are yet to be determined. PMID: 21865942 [PubMed - as Read more at www.ncbi.nlm.nih.gov

 

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Perforated Ulcer After Gastric Bypass; Dangerous & Deadly

Perforated Ulcer After Gastric Bypass; Dangerous & Deadly



Beware of signs sand symptoms of ulcer



Avoid ulcer causing foods and medicines



Eat plain yogurt and treat indigestion, gastritis and ulcers with caution and respect!

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Surg Obes Relat Dis. 2011 Jun 24. [Epub ahead of print] Incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management. Kalaiselvan R, Exarchos G, Hamza N, Ammori BJ. Source Salford Royal Hospital, Salford, United Kingdom. Abstract BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is a well-established procedure to treat morbid obesity. Gastrojejunal anastomotic (GJA) ulcers can develop after surgery with subsequent perforation. Our aim was to evaluate the incidence, presentation and outcome of management of perforated GJA ulcer disease after laparoscopic RYGB. METHODS: The database of all patients at the senior author's bariatric institutions was retrospectively reviewed. The results are presented as mean (range). RESULTS: From April 2002 to April 2010, 1213 patients underwent laparoscopic RYGB, which included 1184 primary and 29 revision procedures. The operative mortality was .15%. Ten patients developed perforated GJA ulcers (.82%) at a mean of 13.5 (6-19) months. The patients who presented to bariatric surgeons (n = 5) were treated with laparoscopic closure and an omental patch, and those who presented to nonbariatric surgeons (n = 5) were treated with laparotomy. The morbidity and mortality rate was 30% and 10%, respectively, and the mean postoperative hospital stay for the survivors was 14 (5-44) days. CONCLUSION: Perforated GJA ulcers can develop in 1 of 120 patients after laparoscopic RYGB and can be effectively managed by laparoscopic repair with an omental patch, if expertise is available. Read more at www.ncbi.nlm.nih.gov

 

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RNY Gastric Bypass Poor; Duodenal Switch Worse?

Editorial says weight loss surgery should not be done for weight loss?



Now you know why we like the MGB.



Better long term weight loss than RNY, less complications than DS/BPD

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From Medscape Education Clinical Briefs

Adverse Events of Duodenal Switch Surgery May Outweigh Benefits CME

News Author: Laurie Barclay, MD CME Author: Charles P. Vega, MD

Study Synopsis and Perspective

Compared with gastric bypass bariatric surgery, the harms of duodenal switch surgery may outweigh the benefits, according to the results of a randomized controlled trial reported in the September 6 issue of the Annals of Internal Medicine.

"Gastric bypass and duodenal switch are currently performed bariatric surgical procedures," write Torgeir T. Søvik, MD, and colleagues. "Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass."

In an accompanying editorial, Edward H. Livingston, MD, from the University of Texas Southwestern Medical Center in Dallas, notes that bariatric operations have a very high rate of lifelong complications and a minimal effect on overall survival duration.

"Bariatric operations should be done to control an immediate medical problem that surgically induced weight loss is expected to resolve; examples include diabetes and sleep apnea," Dr. Livingston writes. "In this context, weight loss per se is not the goal, but rather control of comorbid conditions. Thus, duodenal switch is not an appropriate operation because the added weight loss compared with gastric bypass is offset by complications that far outweigh any potential benefits." Read more at www.medscape.org

 

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MGB Surgery Resource Online Videos

MGB Surgery Resource Online Videos

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The Mini-Gastric Bypass The “30 minute” Gastric Bypass, Get The MGB for Life! Search Search for: Go Home Subscribe

Animation of Mini-Gastric Bypass Video Animation ofMini-Gastric Bypass Video Dr.Rutledge Mini-Gast… MGBIntOpMovie.wmv MGB Port Placement: MGBPortPlacement: Dr. Rutledge believes that; The “Mini”-g… Mini-Gastric Bypass Intra-Operative Video Mini-Gastric Bypass Intra-operative Video. Dr. Rutledge Mini-… MGB Port Placement: MGBPortPlacement: Dr. Rutledge believes that; The “Mini”-g… Failed LapBand Converted to Mini-Gastric Bypass Failed Lap Band Converted to Mini-Gastric Bypass. Dr. Rutledg… MGB Port Placement:; MGBPrtPlcmntFrmrBndPt MGBPortPlacement: Dr. Rutledge believes that; The “Mini”-g… Mini-Gastric Bypass Intra-Operative Video Mini-Gastric Bypass Intra-operative Video. Dr. Rutledge Mini-… MGB Port Placement: MGBPrtPlcmnt0FrmrBndPt2 MGBPortPlacement: Dr. Rutledge believes that; The “Mini”-g… Part 1: Operative Video; Tips and Tricks-Mini-Gastric Bypass Part 1: Dr Rutledge offers tips and techniques to perform the … Part 2: Dr Rutledge offers tips and techniques to perform the Mini-Gastric Bypass Part 2: Dr Rutledge offers tips and techniques to perform the … Part 3: Intraop Video of the Mini-Gastric Bypass Part 3: Dr Rutledge offers tips and techniques to perform the . Part 4: Narrated OR MGB Video; Dr Rutledge offers tips and techniques Part 4: Dr Rutledge offers tips and techniques to perform the … Dr Rutledge offers tips and techniques Mini-Gastric Bypass Part 5: Dr Rutledge offers tips and techniques to perform the MGB Bile Reflux MGB MGB PortPlacement RevisionMGB Mini-Sleeve Gastroplasty SLS Presentation 2010 Mini-Sleeve Gastroplasty SLS Presentation 2010 Dr. Rutledge’s. IntraOp Video Mini-Gastric Bypass IntraOp Video Mini-Gastric Bypass The Story of the Mini-Gastric Bypass Video, Dr. Rutledge, MGB The Story of the Mini-Gastric Bypass Video, Dr. Rutledge, MGB … MGBMovie01_0002.wmv MGB3Movie.wmv MGBMovie01_0001.wmv MGB2Movie.wmv RemoveBand.mp4 VideoMGB.avi Mini-Gastric Bypass Revision Video, Dr. Rutledge, MGB Mini-Gastric Bypass Revision Video, Dr. Rutledge,MGB Dr.Ru… Intraoperative Mini-Gastric Bypass Video, Dr. Rutledge, MGB Dr. Rutledge Mini-Gastric Bypass, MGB, Video. Contact Info:… 100 Failed Lap Bands(R), Intra-Operative Video; Dr. Rutledge Mini-Gastric Bypass 100 Failed Lap Bands (R), Intra-Operative Video; Dr. Rutledge… MGBMovie01_0001_mpeg4.mp4 MGB3Movie_mpeg4.mp4 Diagram MGB, Sleeve and Non-Excisional Sleeve Dr Rutledge discusses MGB, Sleeve and the new “Non-Excisional … Too Thin? We’ll Fix it, Mini-Gastric Bypass Video, Dr. Rutledge, MGB Too Thin? We’ll Fix it, Mini-Gastric Bypass Video, Dr. Rutledg… The Story of the Mini-Gastric Bypass, Dr. Rutledge, MGB The Story of the Mini-Gastric Bypass, Video, Dr. Rutledge, MGB… Failed LapBand Converted to Mini-Gastric Bypass Failed Lap Band Converted to Mini-Gastric Bypass. Dr. Rutledg… Mini-Gastric Bypass Revision Video Mini-Gastric Bypass Revision Video Dr. Rutledge Mini-Gastric … Edit this entry. Read more at minibypass.wordpress.com

 

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IFSO MGB Out Performs RNY

IFSO MGB Out Performs RNY

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Latest Post MGB Out Performs RNY Posted by drrutledge ⋅ September 17, 2011 IFSO 2011 MGB Outperforms RnY Bypass The Mini-Gastric Bypass Outperforms the RNY Gastric Bypass as Measured by Length of Stay (LOS) http://static.slidesharecdn.com/swf/ssplayer2.swf?doc=ifso2011-mgboutperformsrny-110916201136-phpapp02&stripped_title=ifso-2011-mgb-outperforms-rny-bypass&userName=DrRRMD View more presentations from DrR Rutledge. Read more at minibypass.wordpress.com

 

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What's Best Weight Loss Surgery

A Structured Approach to Decision Making:

Choosing the Best Weight Loss Surgery



R Rutledge MD,

The Centers for Laparoscopic Obesity Surgery

www.CLOS.net

Email: DrR@clos.net





Abstract

Introduction

Obesity is now at epidemic proportions. Surgery has been found be a successful but flawed treatment. Several procedures have failed and been abandoned. Systematic tools help make rational decisions. The purpose was to apply tools to decision of selecting the “best” operation.

Methods

The Proact system was applied to the problem of selecting the Best” form of weight loss surgery. PR: Define the Problem, O: Objectives: Criteria for Success, A: Alternatives: Available Options, C: Consequences: Outcomes/Results, T: Tradeoffs: Weigh Pros & Cons. Proact is a systematic tool to make decisions.

Results

PR: State the Problem: Obesity epidemic with surgery essentially the only successful therapy, but present surgical procedures deeply flawed, leading to a spectrum of competing procedures. O: Objectives; we seek an "Ideal" Weight Loss Surgery. 30 point mul

Conclusions

Bariatric surgery is now racked with controversy. At least a dozen different procedures and variations vie for position as the “best” procedure for the treatment of obesity. Logical decision making by humans is often flawed and systems like Proact have been designed to aide in improving rational decision making. Applying the Proact tool to this problem allows use of a 30 point performance assessment tool. Arguably the Mini-Gastric Bypass meets this performance tool. The primary tradeoff has been seen to be the long term fear of gastric cancer when carefully reviewed is shown to be an insignificant concern.

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Views: 2 Comments: 0 Responses: 0 0 | 0 6:47 Choose Best Weight Loss Surgery Choose Best Weight Loss Surgery Pr: Choice of Obesity Surgery... Choose Best Weight Loss Surgery Pr: Choice of Obesity Surgery O: Objectives "Ideal" Weight Loss Surgery A: RNY, Band, Sleeve, MGB C: MGB meets almost all objectives/success criteria T: Fear of Gastric Cancer Not Supported by the Data Rational Decision Making: Best Choice; Mini-Gastric Bypass September 16, 2011 12:44 AM Public Published 100% Monetized Read more at www.youtube.com

 

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DrR's Presentation in India; Obesity Surgery Society of India

A Structured Approach to Decision Making:

Choosing the Best Weight Loss Surgery



R Rutledge MD,

The Centers for Laparoscopic Obesity Surgery

www.CLOS.net

Email: DrR@clos.net





Abstract

Introduction

Obesity is now at epidemic proportions. Surgery has been found be a successful but flawed treatment. Several procedures have failed and been abandoned. Systematic tools help make rational decisions. The purpose was to apply tools to decision of selecting the “best” operation.

Methods

The Proact system was applied to the problem of selecting the Best” form of weight loss surgery. PR: Define the Problem, O: Objectives: Criteria for Success, A: Alternatives: Available Options, C: Consequences: Outcomes/Results, T: Tradeoffs: Weigh Pros & Cons. Proact is a systematic tool to make decisions.

Results

PR: State the Problem: Obesity epidemic with surgery essentially the only successful therapy, but present surgical procedures deeply flawed, leading to a spectrum of competing procedures. O: Objectives; we seek an "Ideal" Weight Loss Surgery. 30 point mul

Conclusions

Bariatric surgery is now racked with controversy. At least a dozen different procedures and variations vie for position as the “best” procedure for the treatment of obesity. Logical decision making by humans is often flawed and systems like Proact have been designed to aide in improving rational decision making. Applying the Proact tool to this problem allows use of a 30 point performance assessment tool. Arguably the Mini-Gastric Bypass meets this performance tool. The primary tradeoff has been seen to be the long term fear of gastric cancer when carefully reviewed is shown to be an insignificant concern.

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Views: 2 Comments: 0 Responses: 0 0 | 0 6:47 Choose Best Weight Loss Surgery Choose Best Weight Loss Surgery Pr: Choice of Obesity Surgery... Choose Best Weight Loss Surgery Pr: Choice of Obesity Surgery O: Objectives "Ideal" Weight Loss Surgery A: RNY, Band, Sleeve, MGB C: MGB meets almost all objectives/success criteria T: Fear of Gastric Cancer Not Supported by the Data Rational Decision Making: Best Choice; Mini-Gastric Bypass September 16, 2011 12:44 AM Public Published 100% Monetized Read more at www.youtube.com

 

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The effect of 4-week chilli supplementation

When analysed separately, men had a lower resting heart rate (P=0.02) and higher subendocardial-viability ratio (P=0.05) at the end of the chilli diet than the bland diet.

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Eur J Clin Nutr. 2007 Mar;61(3):326-33. Epub 2006 Aug 23. The effect of 4-week chilli supplementation on metabolic and arterial function in humans. Ahuja KD, Robertson IK, Geraghty DP, Ball MJ. Source School of Human Life Sciences, University of Tasmania, Launceston, TAS, Australia. Erratum in Eur J Clin Nutr. 2007 Mar;61(3):442. Abstract OBJECTIVE: To investigate the effects of regular chilli ingestion on some indicators of metabolic and vascular function. DESIGN: A randomized cross-over dietary intervention study. SETTING: Launceston, Australia. SUBJECTS: Healthy free-living individuals. INTERVENTION: Thirty-six participants (22 women and 14 men), aged 46+/-12 (mean+/-s.d.) years; BMI 26.4+/-4.8 kg/m(2), consumed 30 g/day of a chilli blend (55% cayenne chilli) with their normal diet (chilli diet), and a bland diet (chilli-free) for 4 weeks each. Metabolic and vascular parameters, including plasma glucose, serum lipids and lipoproteins, insulin, basal metabolic rate, blood pressure, heart rate, augmentation index (AIx; an indicator of arterial stiffness), and subendocardial-viability ratio (SEVR; a measure of myocardial perfusion), were measured at the end of each diet. In a sub-study, during week 3 of each dietary period, the vascular responses of 15 subjects to glyceryl-trinitrate (GTN) and salbutamol were also studied. RESULTS: For the whole group, there were no significant differences between any of the measured parameters when compared at the end of the two dietary periods. When analysed separately, men had a lower resting heart rate (P=0.02) and higher SEVR (P=0.05) at the end of the chilli diet than the bland diet. In the sub-study, baseline AIx on the chilli diet was lower (P<0.001) than on the bland diet, but there was no difference in the effects of GTN and salbutamol between the two diets. CONCLUSION: Four weeks of regular chilli consumption has no obvious beneficial or harmful effects on metabolic parameters but may reduce resting heart rate and increase effective myocardial perfusion pressure time in men. Read more at www.ncbi.nlm.nih.gov

 

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Hot Peppers are Good

Laboratory studies have shown that the resistance of isolated LDL-cholesterol or linoleic acid to oxidation is increased in incubations with chilli extracts or capsaicin--the active ingredient of chilli.



The rate of oxidation was significantly lower after the chilli diet, compared with the bland diet.

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Laboratory studies have shown that the resistance of isolated LDL-cholesterol or linoleic acid to oxidation is increased in incubations with chilli extracts or capsaicin--the active ingredient of chilli. It is unknown if these in vitro antioxidative effects also occur in the serum of individuals eating chilli regularly. The present study investigated the effects of regular consumption of chilli on in vitro serum lipoprotein oxidation and total antioxidant status (TAS) in healthy adult men and women. In a randomised cross-over study, twenty-seven participants (thirteen men and fourteen women) ate 'freshly chopped chilli' blend (30 g/d; 55% cayenne chilli) and no chilli (bland) diets, for 4 weeks each. Use of other spices, such as cinnamon, ginger, garlic and mustard, was restricted to minimum amounts. At the end of each dietary period serum samples were analysed for lipids, lipoproteins, TAS and Cu-induced lipoprotein oxidation. Lag time (before initiation of oxidation) and rate of oxidation (slope of propagation phase) were calculated. There was no difference in the serum lipid, lipoproteins and TAS at the end of the two dietary periods. In the whole group, the rate of oxidation was significantly lower (mean difference -0.23 absorbance x10(-3)/min; P=0.04) after the chilli diet, compared with the bland diet. In women, lag time was higher (mean difference 9.61 min; P<0.001) after the chilli diet, compared with the bland diet. In conclusion, regular consumption of chilli for 4 weeks increases the resistance of serum lipoproteins to oxidation.

Br J Nutr. 2006 Aug;96(2):239-42.

Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women.

Ahuja KD, Ball MJ.

Source School of Human Life Sciences, University of Tasmania, Launceston, Tasmania 7250, Australia. Read more at www.ncbi.nlm.nih.gov

 

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Leaks in GASTRIC BYPASS AND SLEEVE GASTRECTOMY are among the worst and maybe the most fearful complications in bariatric surgery.



After the initial diagnosis and sepsis stabilization an endoscopic therapeutic plan should be assigned.



From the healing perspective, it seems like the two procedures has different outcomes in term of leakage.



On the gastric bypass most of the leaks heals up to 30 days and a conservative approach is advisable.



After this period and endoscopy should be performed having in mind the observation of he pouch itself with close attention to the staple line at were the greater curvature was stapled and transected, the gastro-jejunostomy (GJ) and the alimentary limb.



The master statement that a to treat a digestive leak the obstructions (stenosis) have to be removed always applies and if the endoscope do



not pass trough the GJ, dilation should be done as first move. Traditional

therapeutic endoscopy like biological glue, clips and meshes should be used t http://amplify.com/u/a1cf6b

In 91 patients removal of gastric banding and sleeve gastrectomy was carried out as the same operation. The leakage rate was 4.4% with an intraoperative complication rate of 5.5%.

PL 02–07 Leakage Rate of Sleeve Gastrectomy after Gastric Banding

PRESENTER: C. Stroh, Co-authors: Study Group Bariatric Surgery, SRH Wald-Klinikum Gera, Gera, Germany http://amplify.com/u/a1cf62

"Lap Sleeve Gastrectomy" is not standardized yet. Long-term results are variable. Leaks at the esophageal-gastric junction (EGJ) are the most serious technical complication.

Staple-line “protection” is a matter of debate. Many authors do not protect the stapleline

an others use cushion allograph material. http://amplify.com/u/a1cf5v

After 6 years experiences with laparoscopic adjustable gastric banding we

changed to the Roux-en-Y-gastric bypass (RNYGB) and the Omega-loop-Gastric bypass (OLGB) into our program. 10 Years Experiences with Both - Roux-En-Y- and Omega-LoopGastric Bypass, PRESENTER: R.A. Weiner, Krankenhaus Sachsenhausen, Chirurgie, Frankfurt/M, Germany http://amplify.com/u/a1cf5q

Orlistat Helpful in Fat and Metabolic Disease?

These findings suggest that over-the-counter 60 mg orlistat, in combination with the type of advice a subject could expect to be given when obtaining 60 mg orlistat in a community setting, does indeed result in potentially clinically beneficial changes in body composition and risk factors for metabolic diseases.

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Eur J Clin Nutr. 2011 Jun 22. doi: 10.1038/ejcn.2011.108. [Epub ahead of print] Pragmatic study of orlistat 60 mg on abdominal obesity. Thomas EL, Makwana A, Newbould R, Rao AW, Gambarota G, Frost G, Delafont B, Mishra RG, Matthews PM, Berk ES, Schwartz SM, Bell JD, Beaver JD. Source Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK. Abstract Background/Objectives:It is well established that combining a reduced calorie, low-fat diet with the lipase inhibitor orlistat results in significantly greater weight loss than placebo plus diet. This weight loss is accompanied by changes in adipose tissue (AT) distribution. As 60 mg orlistat is now available as an over-the-counter medication, the primary objective of this study was to determine whether 60 mg orlistat is effective as a weight loss option in a free-living community population with minimal professional input.Methods:AT and ectopic lipid content were measured using magnetic resonance imaging and (1)H MR spectroscopy, respectively, in 27 subjects following 3 months treatment with orlistat 60 mg and a reduced calorie, low-fat diet.Results:Significant reductions in intra-abdominal AT (-10.6%, P=0.023), subcutaneous (-11.7% P<0.0001) and pericardial fat (-9.8%, P=0.034) volumes and intrahepatocellular lipids (-43.3%, P=0.0003) were observed. These changes in body fat content and distribution were accompanied by improvements in plasma lipids and decreases in blood pressure and heart rate.Conclusion:These findings suggest that over-the-counter 60 mg orlistat, in combination with the type of advice a subject could expect to be given when obtaining 60 mg orlistat in a community setting, does indeed result in potentially clinically beneficial changes in body composition and risk factors for metabolic diseases.European Journal of Clinical Nutrition advance online publication, 22 June 2011; doi:10.1038/ejcn.2011.108 Read more at www.ncbi.nlm.nih.gov

 

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Orlistat 60 mg Reduces Visceral Adipose Tissue

These results suggest that orlistat 60 mg may be an effective weight loss tool to reduce metabolic risk factors associated with abdominal obesity.

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Obesity (Silver Spring). 2011 Sep;19(9):1796-803. doi: 10.1038/oby.2011.143. Epub 2011 Jun 30. Orlistat 60 mg Reduces Visceral Adipose Tissue: A 24-Week Randomized, Placebo-Controlled, Multicenter Trial. Smith SR, Stenlof KS, Greenway FL, McHutchison J, Schwartz SM, B Dev V, Berk ES, Kapikian R. Source BioImaging, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA. Abstract It is well established that abdominal obesity or upper body fat distribution is associated with increased risk of metabolic and cardiovascular disease. The purpose of the present study was to determine if a 24 week weight loss program with orlistat 60 mg in overweight subjects would produce a greater change in visceral adipose tissue (VAT) as measured by computed tomography (CT) scan, compared to placebo. The effects of orlistat 60 mg on changes in total fat mass (EchoMRI-AH and BIA), ectopic fat (CT) and glycemic variables were assessed. One-hundred thirty-one subjects were randomized into a multicenter, double-blind placebo controlled study in which 123 subjects received at least one post baseline efficacy measurement (intent-to-treat population). Both orlistat-and placebo-treated subjects significantly decreased their VAT at 24 weeks with a significantly greater loss of VAT by orlistat treated subjects (-15.7% vs. -9.4%, P < 0.05). In addition, orlistat-treated subjects had significantly greater weight loss (-5.93 kg vs. -3.94 kg, P < 0.05), total fat mass loss (-4.65 kg vs. -3.01 kg, P < 0.05) and trended to a greater loss of intermuscular adipose tissue and content of liver fat compared with placebo-treated subjects. This is the first study to demonstrate that orlistat 60 mg significantly reduces VAT in addition to total body fat compared to placebo treated subjects after a 24 week weight loss program. These results suggest that orlistat 60 mg may be an effective weight loss tool to reduce metabolic risk factors associated with abdominal obesity. Read more at www.ncbi.nlm.nih.gov

 

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Orlistat has antitumor effects?

Orlistat has antitumor effects?

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Biomed Pharmacother. 2011 Jul;65(4):286-92. Epub 2011 Jun 12. Antitumor effect of orlistat, a fatty acid synthase inhibitor, is via activation of caspase-3 on human colorectal carcinoma-bearing animal. Chuang HY, Chang YF, Hwang JJ. Source Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Beitou, Taipei 112, Taiwan. Abstract We established a HT-29/tk-luc human colorectal carcinoma-bearing animal model for the study of the inhibition effect and mechanism of orlistat, a fatty acid synthase (FASN) inhibitor. The results showed that orlistat caused cell cycle arrest at G1 phase, and triggered apoptosis through caspase-3 activation. The tumor inhibition effect of orlistat may also due to the inhibition of fatty acid synthesis without altering FASN activity. The tumor size of orlistat-treated mice in vivo was significantly smaller than that of the controls with 55% inhibition. The therapeutic efficacy was further confirmed with the bioluminescent imaging and nuclear molecular imaging with ¹³¹I-FIAU/gamma scintigraphy and ¹¹C-acetate/microPET. We suggest that FASN is a potential target for the treatment of human colorectal carcinoma. Read more at www.ncbi.nlm.nih.gov

 

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Orlistat Improves Diabetes

Orlistat improved lipid profile and led to faster glycaemic control and insulin resistance parameters than the control, without any serious adverse event.

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J Clin Pharm Ther. 2011 Aug 4. doi: 10.1111/j.1365-2710.2011.01280.x. [Epub ahead of print] Effects of 1-year orlistat treatment compared to placebo on insulin resistance parameters in patients with type 2 diabetes. Derosa G, Cicero AF, D'Angelo A, Fogari E, Maffioli P. Source Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy Department of Internal Medicine, Aging and Kidney diseases, "G. Descovich" Atherosclerosis Study Center, University of Bologna, Bologna, Italy. Abstract What is known and Objective:  The behavioural approach is usually slow and not always sufficient to achieve optimal targets in weight and metabolic control in obese diabetic patients, and a pharmacological treatment is often necessary. The aim of this study was to compare the effects of orlistat and placebo on body weight, glycaemic and lipid profile and insulin resistance in patients with type 2 diabetes. Methods:  Two hundred and fifty-four obese, diabetic patients were enrolled in this study and randomized to take orlistat 360 mg or placebo for 1 year. We evaluated at baseline and after 3, 6, 9 and 12 months body weight, waist circumference (WC), body mass index (BMI), glycated haemoglobin (HbA(1c) ), fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), lipid profile, retinol-binding protein-4 (RBP-4), resistin, visfatin and high-sensitivity C-reactive protein (Hs-CRP). Results and Discussion:  We observed a significant reduction in body weight, WC, BMI, lipid profile, RBP-4 and visfatin in the orlistat group but not in control group. Faster improvements in HbA(1c) , PPG, FPI, HOMA-IR, resistin and Hs-CRP were recorded with orlistat than with placebo. A similar decrease in FPG was seen in the two groups. Significant predictors of change in insulin resistance (HOMA-IR) were RBP-4 and resistin concentration in the orlistat group (r = -0·53, P < 0·05, and r = -0·59, P < 0·01, respectively). What is new and Conclusion:  To the best of our knowledge, this is the first study investigating the effect of orlistat on insulin resistance and markers of inflammation. Orlistat improved lipid profile and led to faster glycaemic control and insulin resistance parameters than the control, without any serious adverse event. Orlistat also improved RBP-4 and visfatin, effects not observed with placebo. Read more at www.ncbi.nlm.nih.gov

 

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