Effects of bariatric surgery on gastroesophageal reflux

PURPOSE OF REVIEW: Obesity and gastroesophageal reflux disease (GERD) are two prevalent conditions with important impact on health resource utilization around the world. Obesity is a known risk factor in the pathogenesis of GERD. When conservative measures fail, bariatric surgery remains the only option to lose weight and correct obesity-related comorbidities. The influence of bariatric surgery on GERD depends on which bariatric intervention is used. RECENT FINDINGS: Recent studies indicate that laparoscopic gastric banding and laparoscopic sleeve gastrectomy have little influence on preexisting GERD symptoms and findings, but some patients may develop GERD after laparoscopic sleeve gastrectomy. A number of studies have documented that laparoscopic Roux-en-Y gastric bypass improves GERD symptoms and findings, making it the preferred procedure for morbid obese patients with concomitant GERD. SUMMARY: Current findings provide good arguments for searching for and treating GERD in patients scheduled to undergo bariatric surgery. The presence of GERD might represent a relative contraindication for sleeve gastrectomy or gastric banding or both. Gastric bypass might be the procedure of choice in morbid obese patients with GERD symptoms or findings or both.

Wernicke Encephalopathy: a Future Problem Even After Sleeve Gastrectomy? A Systematic Literature Review.

Wernicke encephalopathy (WE) is a serious complication of bariatric surgery with significant morbidity and mortality. A few cases have been reported in the literature, mainly in patients after a Roux-en-Y gastric bypass. Since sleeve gastrectomy (SG) has become a more established and popular bariatric procedure, WE is expected to appear more frequently after SG. We performed a literature review on WE after SG, and 13 cases have been found to be sufficiently documented. The risk of WE needs to be considered in patients with a prolonged vomiting episode and any type of neurological symptoms, independent of the presence of any surgical complications.

Glucagon-like peptide-1 (GLP-1) receptors are not overexpressed in pancreatic islets from patients with severe hyperinsulinaemic hypoglycaemia following gastric bypass

Glucagon-like peptide-1 (GLP-1) receptors are highly overexpressed in benign insulinomas, permitting in vivo tumour visualisation with GLP-1 receptor scanning. The present study sought to evaluate the GLP-1 receptor status in vitro in other pancreatic disorders leading to hyperinsulinaemic hypoglycaemia, specifically after gastric bypass surgery.

Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008

Gallstone formation is common in obese patients, particularly during rapid weight loss. Whether a concomitant cholecystectomy should be performed during laparoscopic gastric bypass surgery is still contentious. We aimed to analyze trends in concomitant cholecystectomy and laparoscopic gastric bypass surgery (2001-2008), to identify factors associated with concomitant cholecystectomy, and to compare short-term outcomes after laparoscopic gastric bypass with and without concomitant cholecystectomy.

Orientación espacial en las redes sociales en línea Facebook y Tuenti

El objetivo de investigación es cómo los usuarios de Facebook y Tuenti de la ciudad de Málaga utilizan los deícticos espaciales aquí, ahí y allí en dichas redes sociales en línea. En el centro de atención no está cómo o qué es el espacio sino cómo los hablantes interpretan el espacio mediante la lengua, en otras palabras, es la percepción del espacio lo que nos interesa. La Computer-mediated Communication (CMC) ‘comunicación mediada por ordenadores’ es un campo relativamente nuevo. Uno de los fenómenos más interesantes dentro de la comunicación mediada por ordenadores son las redes sociales en línea, que en pocos años se han convertido en un medio de comunicación muy difundido y en expansión continua. No sorprende por eso que la lengua y la comunicación misma se vean afectadas. La condición virtual es importante para comprender los nuevos medios electrónicos de comunicación. Se considera el espacio virtual como una realidad virtual, llena de imágenes, algunas de las cuales no existen sino en un formato electrónico, y otras son representaciones simbólicas del mundo físico, es decir, es un universo paralelo creado y sostenido por las líneas de comunicación y redes de ordenadores que se enlazan por medio de la infraestructura que da Internet. El espacio virtual es básicamente un espacio-sistema relacional. Su realidad se construye a través de la interacción y del intercambio de información; es espacio y es medio. Este carácter emergente del espacio virtual hace esencial vincularlo con aquello que determina su surgimiento: con la comunicación. El espacio virtual surge en y por la comunicación, de ahí su doble naturaleza de espacio y medio. Teniendo en cuenta lo anteriormente dicho, lo que nos interesa analizar es cómo funcionan los deícticos espaciales, en tanto rasgos orientativos de la lengua relativos al lugar del acto de habla. El estudio que presentamos se basa en un corpus elaborado a partir de enunciados de informantes en Facebook y Tuenti. Se ha efectuado un análisis cuantitativo mediante la herramienta AntConc y también un análisis cualitativo. A partir del corpus y su análisis se muestra que los deícticos pueden hacer referencia tanto al espacio real como al virtual, es decir, operan en varios niveles. Su percepción y la interrelación del espacio virtual y real son elementos esenciales que condicionan la orientación espacial en Facebook y Tuenti.

Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery.

PURPOSE Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgery longer than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years. MATERIALS AND METHODS One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters. RESULTS In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up to cholecystectomy was 21.5 months with the latest operation after 51 months. CONCLUSION Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.