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Gastroesophageal Relfux Disease in Morbid Obesity Patients.

Journal of Metabolic and Bariatric Surgery.2017;6(1):19-23. doi:10.17476/jmbs.2017.6.1.19

There has been a sharp increase in the number of obese people worldwide thanks to modern prosperity in accordance with rapid industrialization and economic development. Recently, bariatric surgery has been applied actively to extremely obese patients (BMI>35 kg/m2) and presented as an alternative solution to provide not only weight loss but also a treatment for metabolic diseases such as diabetes mellitus, hypertension, and hyperlipidemia. Gastroesophageal reflux disease (GERD) is one of the most important diseases in morbidly obese patients, and many patients suffer from symptoms like epigastric pain, regurgitation, and dry cough. However, such symptoms are easy to be overlooked and studies on GERD are scarce in relation to bariatric surgery. In morbidly obese patients, high abdominal pressure leads to a pressure gradient between esophagus and stomach. This induces a hiatal hernia causing a greater likelihood of GERD. Many studies in regards to GERD were made after bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric band), and various results have been presented. Studies should be carried out on pre-operative diagnosis of GERD, choice of operative method, and improvement of symptoms after the operation. Research is also needed upon bariatric operation in patients with uncontrolled GERD.
Bariatric Surgery ; Cough ; Diabetes Mellitus ; Diagnosis ; Economic Development ; Esophagus ; Gastrectomy ; Gastric Bypass ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hyperlipidemias ; Hypertension ; Metabolic Diseases ; Methods ; Obesity, Morbid* ; Stomach ; Weight Loss

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Endoluminal Gastroplasty for Obesity Treatment: Emerging Technology and Obstacles.

Seung Han KIM ; Hyuk Soon CHOI ; Hoon Jai CHUN

Journal of Metabolic and Bariatric Surgery.2017;6(1):12-18. doi:10.17476/jmbs.2017.6.1.12

Obesity is a complex metabolic disease. Currently, obesity treatment includes lifestyle modification, obesity drug treatment, and bariatric surgery. Lifestyle modification is an essential part of obesity treatment, but it is limited by itself. And anti-obesity treatment drugs also showed limited weight loss effect, about 3-9% per year, and can cause serious side effects such as cardiovascular side events. Surgical treatment requires high cost, permanent resection of the gastrointestinal tract and can cause complication related to surgery. Recently, several promising endoscopic bariatric therapies are emerging. Endoluminal bariatric treatment using flexible gastrointestinal endoscopy could offer a minimally invasive treatment aimed at achieving an effect comparable to obesity surgery, while offering advantages of low cost and safety. In this paper, we described a new technological method, recent clinical data, and the latest findings on obstacles to be overcome for endoscopic gastroplasty using endoscopic suture instruments. Endoscopic gastroplasty presented reduced gastric volume, effective weight loss and maintenance effect without severe adverse events. It could suggest an attractive treatment option for obesity.
Bariatric Surgery ; Bariatrics ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrointestinal Tract ; Gastroplasty* ; Life Style ; Metabolic Diseases ; Methods ; Obesity* ; Sutures ; Weight Loss

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Insulin Resistance Changes after Metabolic/Bariatric Surgery.

Bu Kyung KIM ; Kyung Won SEO

Journal of Metabolic and Bariatric Surgery.2017;6(1):6-11. doi:10.17476/jmbs.2017.6.1.6

The concept of bariatric surgery, which was intended to lose weight, has turned into metabolic surgery. These changes were due to the fact that the resolution of diabetes and metabolic diseases after weight loss surgery were not associated with weight loss. The key pathogenesis of type 2 diabetes is explained by increased insulin resistance and reduced insulin secretion. Therefore, postoperative resolution of diabetes can be explained by improvement of insulin secretion or insulin resistance. It is known that the improvement of insulin secretion after surgery depends on the degree of preservation of preoperative beta cell function. In this study, the method of measuring insulin resistance is concretely summarized, and the improvement of diabetes after metabolic obesity surgery is focused on the improvement of insulin resistance.
Bariatric Surgery ; Insulin Resistance* ; Insulin* ; Metabolic Diseases ; Methods ; Obesity ; Weight Loss

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Weight Loss Medication in Bariatric Surgery.

Sang Eok LEE

Journal of Metabolic and Bariatric Surgery.2017;6(1):1-5. doi:10.17476/jmbs.2017.6.1.1

Obesity is a chronic disease with serious health consequences, but weight loss is difficult to maintain through lifestyle intervention alone. Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. Since the properly executed pharmacologic treatment is a good option for weight reduction. Surgeons should be aware of the efficacy and side effects of medical treatment.
Bariatric Surgery* ; Chronic Disease ; Humans ; Life Style ; Obesity ; Surgeons ; Weight Loss*

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Spontaneous Unbuckling of the Adjustable Gastric Band; A Rare Complication.

Ji Sun HONG ; Sang Moon HAN

Journal of Metabolic and Bariatric Surgery.2015;4(2):46-48.

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.
Calibration ; Female ; Humans ; Mortality ; Postoperative Period ; Vomiting ; Weight Loss ; Young Adult

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Single Incisional Laparoscopic Sleeve Gastrectomy and Adolescent Bariatric Surgery: Case Report and Brief Review.

Young Suk PARK ; Do Joong PARK ; Ki Hyun KIM ; Dong Jin PARK ; Sang Hoon AHN ; Hyung Ho KIM

Journal of Metabolic and Bariatric Surgery.2015;4(2):40-45.

Single incisional laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative approach to the conventional multiport laparoscopic procedure. However, there has been no reported SILSG case in Korea, even though single incisional laparoscopic distal gastrectomy for early gastric cancer has increasingly reported in Korea and Japan. We recently performed 5 cases of SILSG for morbidly obese Korean patients, one of whom was 14-year-old adolescent female patient. Here, we describe our technical strategy for SILSG and present a brief review of literature about adolescent bariatric surgery.
Adolescent* ; Bariatric Surgery* ; Female ; Gastrectomy* ; Humans ; Japan ; Korea ; Stomach Neoplasms

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Effect of Bariatric Surgery on Hypertension.

Hana ALHOMOUND ; Sungsoo PARK

Journal of Metabolic and Bariatric Surgery.2015;4(2):35-39.

High blood pressure is a serious health problem and a primary risk factor for both stroke and heart disease. Many studies have strongly assessed short-term effects as well as long-term effects of bariatric surgery on type2 diabetes mellitus, whereas little attention has been paid to the effect on hypertension. This review study was designed to evaluate the impact of Bariatric Surgery and weight loss on obese patients with hypertension, and whether the hypertension improved or resolved post-surgery. Relevant papers were searched using MEDLINE, Science Citation Index, Pub Med, and Clinical Evidence, by using the searched terms (Hypertension, Bariatric, Obesity, and Surgery). The association between weight reduction and Hypertension control is hard to analyze. And well-organized studies with a long term follow up are required to determine the effect of Bariatric Surgery and Hypertension control.
Bariatric Surgery* ; Diabetes Mellitus ; Follow-Up Studies ; Heart Diseases ; Humans ; Hypertension* ; Obesity ; Risk Factors ; Stroke ; Weight Loss

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Modulation of Gut Microbiota: Potential Mechanism of Diabetes Remission after Bariatric/Metabolic Surgery.

Yeon Ju HUH ; Joo Ho LEE

Journal of Metabolic and Bariatric Surgery.2015;4(2):29-34.

Advances in genomic processing technology have been applied to the human microbiota and have provided the understanding of the effect of the microbiota in human health and disease. Especially, studies of the gut microbiota have revealed that changes in gut microbiota are related to obesity and the metabolic syndrome. With weight gain, there is an increase in the ratio of Firmicutes to Bacteroidetes. Certain bacteria have increased the ability to ferment dietary substrates, thereby increasing hosts' energy intake and weight gain. After transplantation of microbiota from lean donors, insulin sensitivity of recipients increased along with proliferation of butyrate-producing intestinal microbiota. One important finding after Roux-en-Y gastric bypass is the relative overabundance of Proteobacteria, which is different with the changes seen in weight loss without bypass surgery. Due to the change of microbiota's composition after bypass surgery, the gut environment is changed to unfavorable for energy absorption including decrease of polysaccharide fermentation. Therefore this change may contribute to the improvement of insulin resistance and loss of body weight. According to these results, modifying the gut microbiota through diet, probiotics, fecal transplants, and surgery might be included as therapeutic options for the diseases linked to imbalance in the microbiota.
Absorption ; Bacteria ; Bacteroidetes ; Bariatric Surgery ; Body Weight ; Diabetes Mellitus ; Diet ; Energy Intake ; Fermentation ; Gastric Bypass ; Humans ; Insulin Resistance ; Microbiota* ; Obesity ; Probiotics ; Proteobacteria ; Tissue Donors ; Weight Gain ; Weight Loss

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Obesity in the Elderly and Bariatric Surgery.

Ju Hee LEE

Journal of Metabolic and Bariatric Surgery.2015;4(1):6-10.

The prevalence of morbid obesity is rising progressively among elderly patients in the world. The incidence of obesity in Koreans, 60 years and older was 34.2% in 2012. Although there was no consensus on criteria for weight loss management in aged persons, it is clear that weight loss therapy improves metabolic syndrome, physical function and health-related quality of life in obese older persons. The current therapeutic tools available for weight management in older persons do not differ from those for weight management in general; 1) lifestyle intervention involving diet, physical activity, and behavior modification; 2) pharmacotherapy; and 3) surgery. Currently, bariatric surgery can be safely performed with low morbidity and mortality rates in obese older people. In addition, the elderly can lose clinically significant amounts of weight after bariatric surgery and significant weight reduction is associated with an improvement in obesity-related co-morbidities and an overall reduction in medication requirements. Patient selection for bariatric surgery should not be based on age alone.
Aged* ; Bariatric Surgery* ; Behavior Therapy ; Consensus ; Diet ; Drug Therapy ; Humans ; Incidence ; Life Style ; Mortality ; Motor Activity ; Obesity* ; Obesity, Morbid ; Patient Selection ; Prevalence ; Quality of Life ; Weight Loss

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Assessment Parameters after Bariatric Surgery.

Han Hong LEE

Journal of Metabolic and Bariatric Surgery.2015;4(1):1-5.

Body weight and body mass index (BMI) to be simply measured and analyzed are most common methods to assess the effect of bariatric surgery. In addition, measurement of subcutaneous and visceral adipose tissues by imaging technique has been adapted as a kind of anthropometrics. After bariatric surgery, obese patients with metabolic disorder are tested by conventional parameters such as fasting blood glucose, blood lipid panel, insulin level and blood pressure. Recently, the adipokines associated with inflammation, such as high-sensitive C-reactive protein and adiponectin, are accepted as new measure of follow-up examination. In this review, various measurement parameters, from anthropometrics to cytokine, to assess the effect of bariatric surgery are introduced, so that bariatric surgeons could keep in mind its significance in Korea where bariatric surgery is still unpopular.
Adipokines ; Adiponectin ; Bariatric Surgery* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; C-Reactive Protein ; Fasting ; Follow-Up Studies ; Humans ; Inflammation ; Insulin ; Korea

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