A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss

Abstract Background Cholesterol metabolism has dramatically changed under hyperthyroid status. However, a combination of hyperthyroidism and cholecystolithiasis is very rare. Case presentation We report a case of cholelithiasis accompanied by hyperthyroidism in a 13-year-old girl who had recently lost 13 kg of weight (from 53 to 40 kg) in 1 month without loss of appetite. Ultrasonography showed multiple hyperechoic areas with acoustic shadowing in the gallbladder. Thyroid function tests showed that her serum free triiodothyronine (T3) and thyroxine (T4) levels were elevated and the thyroid-stimulating hormone level was decreased. In addition, serum thyrotropin receptor antibody and thyroid-stimulating antibody were detected. The final diagnosis was cholelithiasis with Graves’ disease. Thiamazole ingestion was started immediately after the diagnosis, and laparoscopic cholecystectomy was performed 33 days after hospitalization. Conclusions Massive and sudden weight loss could be a risk factor for gallstone formation in children. In addition, hyperthyroidism has the potential to promote cholelithiasis via cholesterol metabolism.

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Changes in Gallbladder Motility and Gallstone Formation Following Laparoscopic Gastric Banding for Morbid Obesity

Canadian Journal of Gastroenterology ◽

10.1155/2003/392719 ◽

2003 ◽

Vol 17 (3) ◽

pp. 169-174 ◽

Cited By ~ 34

Author(s):

Bilal O Al-Jiffry ◽

Eldon A Shaffer ◽

Gino TP Saccone ◽

Peter Downey ◽

Lilian Kow ◽

...

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Gastric Banding ◽

Laparoscopic Gastric Banding ◽

Gallstone Formation ◽

Gallbladder Motility ◽

Gallbladder Emptying ◽

Rapid Weight Loss ◽

Obese Patients ◽

Residual Volume

Morbid obesity is associated with cholesterol gallstone formation, a risk compounded by rapid weight loss. Laparoscopic gastric banding allows for a measured rate of weight loss, but the subsequent risk for developing gallstones is unknown.METHOD: Twenty-six normal-weight volunteers (body mass index [BMI] less than 30) were compared with 14 morbidly obese patients (BMI greater than 40). Gallbladder volumes were measured ultrasonographically, after fasting and following stimulation with intravenous cholecystokinin-octapeptide (CCK-8).RESULTS: Preoperatively, fasting gallbladder volume and residual volume after CCK stimulation were both two times greater in the obese group (P<0.02 versus controls). Per cent gallbladder emptying was not different. Gallbladder refilling was four times higher in the obese patients (P<0.01). By six weeks postoperatively, the obese patients lost 1.4±0.1% body weight per week. Gallbladder emptying decreased 18.4% (80.3±3.9% to 65.5±6.9%; P<0.05); residual volume rose one-third (not significant), and refilling fell 60.5% (0.43±0.09 to 0.26±0.04 mL/min; P=0.07). Three patients with weight losses of greater than 1.7% per week developed gallstones; gallbladder emptying fell outside the 95 percentile. By six months, weight loss slowed to 0.5±0.1% per week; gallbladder motility improved modestly. No further stones developed.CONCLUSION: Rapid weight loss following laparoscopic gastric banding impairs gallbladder emptying and when pronounced, gallstones form by six weeks postoperatively. The accompanying reduction in gallbladder emptying, increased gallbladder residual volume and decreased refilling promote gallbladder stasis and hence stone formation.

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M1359 Restore: Randomized Evaluation of Endoscopic Suturing Transorally for Anastomotic Outlet Reduction: A Double-Blind, Sham-Controlled Multicenter Study for Treatment of Inadequate Weight Loss or Weight Regain Following Roux-en-Y Gastric Bypass

Gastroenterology ◽

10.1016/s0016-5085(10)61783-0 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-388 ◽

Cited By ~ 11

Author(s):

Christopher C. Thompson ◽

Mitchell S. Roslin ◽

Bipan Chand ◽

Yang K. Chen ◽

Daniel C. DeMarco ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Multicenter Study ◽

Weight Regain ◽

Endoscopic Suturing ◽

Double Blind ◽

Randomized Evaluation ◽

Inadequate Weight Loss

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Renal Failure, Glomerulonephritis and Morbid Obesity: Improvement after Rapid Weight Loss following Laparoscopic Gastric Bypass

Obesity Surgery ◽

10.1381/0960892052993413 ◽

2005 ◽

Vol 15 (1) ◽

pp. 137-140 ◽

Cited By ~ 21

Author(s):

Flavia C. Soto ◽

Guillermo Higa-Sansone ◽

John B. Copley ◽

Mariana Berho ◽

Colleen Kennedy ◽

...

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Renal Failure ◽

Gastric Bypass ◽

Laparoscopic Gastric Bypass ◽

Rapid Weight Loss

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Case Report: Acute kidney failure leading to permanent haemodialysis due to hyperoxaluria following one-anastomosis gastric bypass-related rapid weight loss.

F1000Research ◽

10.12688/f1000research.22109.2 ◽

2020 ◽

Vol 9 ◽

pp. 155

Author(s):

Angelo Miranda ◽

Andrea Rosato ◽

Andrea Costanzi ◽

Lucia Pisano ◽

Sara Colzani ◽

...

Keyword(s):

Weight Loss ◽

Acute Kidney Injury ◽

Gastric Bypass ◽

Renal Function ◽

Kidney Injury ◽

One Anastomosis Gastric Bypass ◽

Rapid Weight Loss ◽

Post Surgery ◽

Key Factor ◽

The One

The one-anastomosis gastric bypass (OAGB) has been proven to provide good weight loss, comorbidity improvement, and quality of life with follow-up longer than five years. Although capable of improving many obesity-related diseases, OAGB is associated with post-operative medical complications mainly related to the induced malabsorption. A 52-year-old man affected by nephrotic syndrome due to a focal segmental glomerulosclerosis underwent OAGB uneventfully. At three months post-surgery, the patient had lost 40kg, reaching a BMI of 32. The patient was admitted to the nephrology unit for acute kidney injury with only mild improvement in renal function (SCr 9 mg/dl); proteinuria was still elevated (4g/24h), with microhaematuria. A renal biopsy was performed: oxalate deposits were demonstrated inside tubules, associated with acute and chronic tubular and interstitial damage and glomerulosclerosis (21/33 glomeruli). Urinary oxalate levels were found to be elevated (72mg/24h, range 13-40), providing the diagnosis of acute kidney injury due to hyperoxaluria, potentially associated to OAGB. No recovery in renal function was observed and the patient remained dialysis dependent. Early and rapid excessive weight loss in patients affected by chronic kidney insufficiency could be associated with the worsening of renal function. Increased calcium oxalate levels associated with OAGB-related malabsorption could be a key factor in kidney injury.

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Effect of Weight Loss by Gastric Bypass Surgery Versus Hypocaloric Diet on Glucose and Incretin Levels in Patients with Type 2 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-2851 ◽

2008 ◽

Vol 93 (7) ◽

pp. 2479-2485 ◽

Cited By ~ 485

Author(s):

Blandine Laferrère ◽

Julio Teixeira ◽

James McGinty ◽

Hao Tran ◽

Joseph R. Egger ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Oral Glucose ◽

Rapid Weight Loss ◽

Incretin Effect ◽

Equivalent Weight

Abstract Context: Gastric bypass surgery (GBP) results in rapid weight loss, improvement of type 2 diabetes (T2DM), and increase in incretins levels. Diet-induced weight loss also improves T2DM and may increase incretin levels. Objective: Our objective was to determine whether the magnitude of the change of the incretin levels and effect is greater after GBP compared with a low caloric diet, after equivalent weight loss. Design and Methods: Obese women with T2DM studied before and 1 month after GBP (n = 9), or after a diet-induced equivalent weight loss (n = 10), were included in the study. Patients from both groups were matched for age, body weight, body mass index, diabetes duration and control, and amount of weight loss. Setting: This outpatient study was conducted at the General Clinical Research Center. Main Outcome Measures: Glucose, insulin, proinsulin, glucagon, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP)-1 levels were measured after 50-g oral glucose. The incretin effect was measured as the difference in insulin levels in response to oral and to an isoglycemic iv glucose load. Results: At baseline, none of the outcome variables (fasting and stimulated values) were different between the GBP and diet groups. Total GLP-1 levels after oral glucose markedly increased six times (peak:17 ± 6 to 112 ± 54 pmol/liter; P < 0.001), and the incretin effect increased five times (9.4 ± 27.5 to 44.8 ± 12.7%; P < 0.001) after GBP, but not after diet. Postprandial glucose levels (P = 0.001) decreased more after GBP. Conclusions: These data suggest that early after GBP, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure. This could be responsible for better diabetes outcome after GBP.

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O-B01 Role of Ursodeoxycholic acid in prevention of gallstones formation in bariatric patients: need to amend recent BOMSS guidelines

British Journal of Surgery ◽

10.1093/bjs/znab429 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Amit Sharma ◽

Hari Nageswaran ◽

Ahmed Saad ◽

Ameet Patel ◽

Lawrence Best

Keyword(s):

Weight Loss ◽

Placebo Group ◽

Ursodeoxycholic Acid ◽

Meta Analysis ◽

Gallstone Formation ◽

Controlled Trials ◽

Number Needed To Treat ◽

Cochrane Central Register ◽

Rapid Weight Loss ◽

Bariatric Patients

Abstract Background During rapid weight-loss phase following bariatric procedures, biliary cholesterol homeostasis is altered leading to increased propensity to gallstone formation. Incidence of gallstone formation following bariatric procedures is shown to be 10-38%. There is no consensus regarding its prevention and current BOMSS guidelines do not address this issue. This meta-analysis aims to pool high level evidence (RCTs) to assess efficacy of Ursodeoxycholic acid (UDCA) in reducing risk of gallstone formation in this cohort of patients and the need for revision of current guidelines. Methods A systematic literature search was performed using electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PROSPERO and Google Scholar) in line with PRISMA guidelines. Only randomised controlled trials were included without restrictions on study language, year, status of publication and patient’s age. Meta-analysis was performed using Review Manager Software to calculate pooled risk ratios (RR) using random-effects model. Results Fifteen trials were included (3952 patients analysed, 2487 in UDCA and 1465 in placebo group). The overall rate of gallstone formation was 16.0% (6.4% in UDCA vs 31.4% in placebo group). Trials included various bariatric procedures (SG/RYGB/OAGB/AGB/Gastroplasty). UDCA dose ranged from 300 to 1200mg per day. UDCA significantly reduced the risk of post-operative gallstone formation (3952 patients, RR 0.24, 95% CI 0.16-0.37, p < 0.0001). The absolute risk reduction and number needed to treat (NNT) were 25% and 4 respectively. Conclusions Oral Ursodeoxycholic acid treatment following restrictive bariatric surgical procedures significantly reduces the risks of gallstone formation. As such, its regular use in first 6 months (rapid weight-loss phase) can significantly reduce the risk of complications associated with gallstones. Such treatment would be cost effective and benefit 1 in 4 patients. There is significant evidence available on benefits of using UDCA in post-operative bariatric patients and that this should be added to the recent BOMSS guidelines.

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Twelve-year changes in protein profiles in patients with and without gastric bypass surgery

10.1101/2020.08.13.20173666 ◽

2020 ◽

Author(s):

Noha A. Yousri ◽

Rudolf Engelke ◽

Hina Sarwath ◽

Rodrick D. McKinlay ◽

Steven C. Simper ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Rapid Weight Loss ◽

Beneficial Effects ◽

Protein Levels ◽

Post Surgery ◽

Protein Change

Gastric bypass surgery results in long-term weight loss due to re-routing of the gastro-intestinal anatomy and dietary intake alterations. Studies have examined protein change during rapid weight loss (up to 1 year post-surgery), but whether protein changes are maintained long-term after weight stabilization is unknown. To identify proteins and pathways involved with the long-term beneficial effects of weight loss, abundances of 1297 blood-circulating proteins were measured at baseline, 2 and 12 years after Roux-en-Y gastric bypass surgery. Protein changes were compared between 234 surgery and 144 non-surgery subjects with severe obesity, with discovery and replication subgroups. Seventy-one protein changes were associated with 12-year BMI changes and 58 (7 unique) with surgical status. Protein changes, including ApoM, were most strongly associated with long-term changes in lipids (HDL-C and triglycerides). Inflammation, adipogenesis, cellular signaling, and complement pathways were implicated. Short-term improvements in protein levels were maintained long-term, even after some weight regain.

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Excess Body Weight and Gallstone Disease

Visceral Medicine ◽

10.1159/000516418 ◽

2021 ◽

pp. 1-7

Author(s):

Caroline Sarah Stokes ◽

Frank Lammert

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Body Weight ◽

Weight Maintenance ◽

Gallstone Disease ◽

Gallstone Formation ◽

Excess Body Weight ◽

Rapid Weight Loss ◽

Healthy Weight ◽

Symptomatic Gallstones

Background: Approximately one fifth of adults are diagnosed with gallstones worldwide. Of these, around 25% develop gallstone disease (indicated by the presence of symptoms) and undergo cholecystectomy. Summary: The risk of gallstones is influenced by a combination of genetic and lifestyle factors, such as excess body weight. In fact, body mass has been demonstrated to be a major risk factor for symptomatic gallstones. Rapid weight loss can also initiate a prolithogenic state and further increase the likelihood of either gallstone formation or existing gallstones becoming symptomatic; however, sensible weight loss strategies can mitigate this risk. This review discusses the role of excess body weight and the risk of gallstone disease, as well as the options available for the prevention of symptomatic gallstones. Key Messages: Healthy weight loss diets combined with regular physical activity can promote successful weight loss and weight maintenance and reduce the risk of gallstones. Should rapid weight loss be required for health reasons or be expected, e.g., after bariatric surgery, prophylactic ursodeoxycholic acid during the period of weight reduction has been demonstrated to reduce the incidence of gallstones formation or symptomatic gallstone occurrence. The recent German guidelines on gallstones recommend simultaneous cholecystectomy during bariatric surgery but only for those with preexisting symptomatic stones.

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