Researchers unveiled data during this week’s Digestive Disease Week® (DDW®) outlining improved bariatric surgery options and studies that offer new insight into the related toll on the body created by obesity, which causes many individuals to develop cancers of the esophagus and pancreas. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Bariatric surgery is a popular option for those who have been unable to achieve weight loss through diet and exercise alone. However, patients need to weigh operative risks and surgical side effects before deciding to proceed with a surgery of this kind.

According to the National Institutes of Health (NIH), there are an estimated 129.6 million overweight or obese Americans (64 percent) with an increased risk for developing type 2 diabetes, heart disease, stroke, cancer and other disabling medical conditions.

Per-Oral Suturing as a Potential Treatment for Adolescent Obesity – A Pilot Investigation of 12 Patients with 6-Months Follow-up (Abstract #243)

With nearly one in five children overweight or obese, many have wondered if surgical methods could help address this growing epidemic. Adolescent bariatric surgery, however, has been met with great controversy and as a result, more minimally invasive options have been sought.

Investigators of this study looked to test the efficacy of endolumial techniques, specifically per-oral suturing, to determine if this method might offer a safe, effective, minimally invasive way to help adolescents lose weight. This technique has been successful in adult populations, using a scope via the mouth to place three to four sutures to bring together the anterior and posterior walls of the stomach together, thereby reducing the volume of the stomach. This study investigated the efficacy of this procedure on an adolescent population.

Twelve adolescents between the ages of 14 and 17 underwent the Endolumial Vertical Gastroplasty (EVG) procedure. Patients had an average baseline BMI of 38.1 with weights ranging from 80 to 158 kg. The study found that all patients lost weight. Between baseline and six months past procedure, the mean BMI dropped to 27.8.

“For this technique to be successful, patients must also commit to adopt a rigorous post-surgery diet and exercise program that is monitored by a nutritionist,” said Roberto Fogel, MD, with the department of gastroenterology, Hospital de Clinicas Caracas in Venezula. “Endolumial suturing procedures seem to be a safe potential alternative to more invasive surgeries or for use when diet and exercise regimes have failed.”

The study was conducted with patients in Venezuela. Patients were carefully selected based on their willingness to comply with rigorous post-surgical lifestyle changes.

Probiotics After Gastric Bypass Surgery Improve Weight Loss and GI Quality of Life (Abstract #343 )

Researchers searching for solutions to gastric motility issues following gastric bypass surgery discovered some unexpected results including enhanced weight loss, better GI quality of life and lower Hydrogen (H2) breath test values (which measure the level of hydrogen in the breath to diagnose conditions that cause GI symptoms) with the use of probiotics.

A potential complication after gastric bypass surgery is bacterial overgrowth, which may affect gastrointestinal functioning, quality of life and weight loss. In an attempt to combat this bacterial overgrowth and its consequences, patients in this study were given probiotics to restore a good bacterial balance in the digestive system.

“Finding that probiotics can actually enhance weight loss was an unexpected result,” said John M. Morton, MD, MPH, associate professor at the Stanford School of Medicine. “There is no magic bullet for fighting obesity, but this simple dietary supplement may be one more weapon we can add to our arsenal.”

Forty-two patients who had successfully undergone gastric bypass surgery were broken into two randomized groups. One group was given probiotics in the form of 2.4 billion colonies of Lactobacillus daily and the other group served as the control group. The GastroIntestinal Related Quality of Life (GIRQoL) survey, H2 breath test and weight were obtained pre- and post-operatively at three and six months.

At six months, patients receiving the probiotics fared better in all categories including a statistically significant improvement in their GIRQoL and lower H2 breath test values, indicating lower levels of harmful gastrointestinal bacteria. The most surprising aspect of the study was the increased weight loss after surgery with the addition of probiotics. Past studies have shown a difference in gastrointestinal bacteria between obese and lean animals.

Prevalence of Fecal Incontinence (FI) and Urinary Incontinence (UI) after Bariatric Surgery (Abstract # 484)

Researchers studying the prevalence of urinary (UI) and fecal (FI) incontinence in patients who have undergone bariatric surgery to treat obesity have found that FI is not only highly prevalent in this population, but it worsens for a majority of patients after surgery.

Previous research has documented a high prevalence of both UI and FI in women considering bariatric surgery, with an improvement in UI after the surgery. However no previous study has examined both UI and FI. For the purposes of this study, investigators surveyed by questionnaire 194 patients who had undergone bariatric surgery: 159 underwent gastric bypass surgery and 35 had gastric banding.

All patients experienced successful weight loss. The survey found that nearly 75 percent of patients with UI reported either an improvement or no change following the bariatric surgery. These findings were consistent with previous studies. However, 54 percent of patients with solid FI noted that it was worse after surgery while only 12 percent reported an improvement. Forty-four percent of these patients also reported worsening diarrhea and only 12 percent reported an improvement of diarrhea after surgery. Of the patients with liquid FI, half reported a worsening of their condition whereas only 9 percent reported an improvement after surgery.

“There is no question that bariatric surgery is a successful means of treating morbid obesity,” said Arnold Wald, MD, professor of medicine, University of Wisconsin School of Medicine and Public Health, Madison. “However, if we’re going to look at overall quality of life for these patients, we certainly want to work on improving incontinence, which is so often under-recognized and under-treated.”

A Prospective Study of Body Mass Index and Barrett’s Esophagus (Abstract #M1951)

Investigators have found that women who are obese are at significantly increased risk of developing Barrett’s esophagus (BE). The findings are especially significant because the incidence of esophageal cancer is rising faster than any other cancer today, according to Brian Jacobson, MD, MPH, assistant professor of medicine at Boston University Medical Center.

BE is a condition in which acid damages the lining of the esophagus over time. The lining of the esophagus, which normally resembles the cell lining of the cheek, instead begins to look like the small intestine. This condition leads to an increased risk for developing cancer of the esophagus.

Researchers have long known that the higher the body mass index (BMI), the more likely one would have symptoms of acid reflux, characterized by heartburn (a burning sensation in the chest) and regurgitation (stomach contents rising back up into the throat or mouth).

In the current study, researchers from the Nurses’ Health Study investigated more than 18,000 women who had undergone upper GI endoscopy. They then reviewed endoscopy and pathology records from those who reported BE. Since the study subjects have been followed since 1976, and have provided detailed information about their habits and diet over the years, researchers were able to determine cause and effect between obesity and BE. Furthermore, they were able to control for factors such as smoking and diet that might have also affected the measured risk.

“We found that women with a BMI of more than 30 were at excess risk of developing BE,” said Dr. Jacobson. The study showed that women may not be at risk until they are obese. Past research has shown that men who were overweight and obese were at increased risk for BE. This may be because men tend to carry most of their fat in the belly, whereas with women, fat tends to be distributed elsewhere.

“Belly fat may produce hormones that further increases the risk for BE,” said Dr. Jacobson. “This adds to mounting evidence that we need to get our national obesity problem under control because the heavier you are, the more you are at risk for cancer and other diseases.”

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Digestive Disease Week® 2008 (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 17-22, 2008 in San Diego, Calif. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

Contact: Aimee Frank
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American Gastroenterological Association