Medical follow up after bariatric surgery: nutritional and drug issues General recommendations for the prevention and treatment of nutritional deficiencies

2009 ◽  
Vol 35 (6) ◽  
pp. 544-557 ◽  
Author(s):  
O. Ziegler ◽  
M.A. Sirveaux ◽  
L. Brunaud ◽  
N. Reibel ◽  
D. Quilliot
2021 ◽  
pp. 1-3
Author(s):  
Gulay Kocak ◽  
Munevver Gul Avsar ◽  
Cansu Yazar ◽  
Aylia Yesilova ◽  
Gulcagri Yildiz ◽  
...  

Background: Sleeve gastrectomy for weight loss has increased significantly nowadays. Various complications may develop after this surgery that requires long-term follow-up of these patients. Nutrition is the most important aspect of the follow-up. The deficiency of trace elements, fat-soluble and water-soluble vitamins following bariatric surgeries have been well-described complications. Although nutritional supplementations are often initiated after bariatric surgery, the clinical outcomes related to the deficiency of trace elements have not been well known yet. Case Presentation: A 27-year-old woman who underwent a laparoscopic sleeve gastrectomy for surgical treatment of obesity 9 months ago presented to the emergency department with a signs of heart failure. Transthoracic echocardiography revealed dilated, poorly functioning left ventricle with reduced ejection fraction (28.9%) consistent with dilated cardiomyopathy. We assumed nutritional deficiencies secondary to sleeve gastrectomy as a cause of dilated cardiomyopathy, as the patient had inappropriate nutritional supplements after surgery. Laboratory tests revealed selenium and zinc deficiency that supported our hypothesis. Our patient completely recovered with adequate supplementation of selenium, zinc and thiamine. Conclusion: We highlighted that the early diagnosis of dilated cardiomyopathy due to selenium deficiency following bariatric surgery is of great importance since selenium deficiency is a cause of reversible cardiomyopathy.


Author(s):  
Anthony B. Mozer ◽  
Konstantinos Spaniolas ◽  
Walter J. Pories

Dietary intolerance and poor oral intake account for a disproportionate number of emergency department visits and readmissions after bariatric surgery. Micronutrient, vitamin, and protein deficiencies can occur after both malabsorptive and restrictive weight-loss operations, and they are best mitigated against by conscientious preoperative counseling and vigilance in follow-up. Routine vitamin supplementation can prevent the need for unnecessary laboratory testing, while symptoms of dumping syndrome can frequently be managed with dietary and behavioral modification alone. Alternative enteral feeding access for alimentary supplementation can be safely performed surgically or with assistance by interventional radiology, and should be considered in the management of perforation, early anastomotic leak, surgical revision, or patients with refractory malnourishment.


2020 ◽  
pp. bjgp20X714161
Author(s):  
Helen Parretti ◽  
Anuradhaa Subramanian ◽  
Nicola Adderley ◽  
Abbott Sally ◽  
Tahrani Abd ◽  
...  

Abstract Background: Bariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks. Aim: To investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, post-specialist discharge. Design and setting: Retrospective cohort study. Primary care practices contributing to IQVIA Medical Research Data (IMRD)–UK (1/1/2000-17/1/2018). Methods: Participants were adults who had had bariatric surgery with a minimum of three years’ follow-up post-surgery as this study focused on patients discharged from specialist care (at 2yrs post-surgery). Outcomes were annual proportion of patients from 2yrs post-surgery with a record of recommended nutritional screening blood tests, weight measurement and prescription of nutritional supplements, and proportions with nutritional deficiencies based on blood tests. Results: 3137 participants were included and median follow-up post-surgery was 5.7 (4.2-7.6) years. 45-59% had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, e.g. recorded haemoglobin measurement varied between 44.9% (n=629/1400) and 61.2% (n=653/1067). Annual proportions of blood tests specific to bariatric surgery were low, e.g. recorded copper measurement varied between 1.2% (n=10/818) and 1.5% (n=16/1067) (where recommended). Results indicated that the most common deficiency was anemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low. Conclusions: Our study suggests that bariatric surgery patients are not receiving recommended nutritional monitoring post-specialist discharge. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand reasons underpinning our findings.


2021 ◽  
Vol 12 ◽  
Author(s):  
Aura D. Herrera-Martínez ◽  
Sonia Junquera-Bañares ◽  
Lucía Turrión-Merino ◽  
Francisco Arrieta-Blanco ◽  
José Botella-Carretero ◽  
...  

Bariatric surgery is one of the most effective treatments currently available for obesity and its derived comorbidities. However, complications may occur, especially when malabsorptive surgeries like a biliopancreatic diversion is performed. We present the case of a female patient whose obesity was treated with this technique, and in the 9th year of follow-up developed an extensive dermatitis secondary to zinc deficiency and malnutrition, precipitated by therapeutic non-compliance. A close surveillance of early symptoms and signs of nutritional deficiencies as well as chronic supplementation of vitamins and trace elements is required; this case illustrates the relevance of periodical, lifelong visits to a medical physician with special training and experience in the management of post bariatric surgery patients in order to prevent, diagnosis and early treat related complications.


2017 ◽  
Vol 176 (4) ◽  
pp. D1-D15 ◽  
Author(s):  
Andrew J Beamish ◽  
Thomas Reinehr

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.


Author(s):  
Yassmin Salaheldin ◽  
Walid El Ansari ◽  
Esraa Aljaloudi ◽  
Wahiba Elhag

Abstract Introduction Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency. Case report We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy). Conclusion Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery. Level of evidence Level V, case report.


Author(s):  
Rana Halloun ◽  
Ram Weiss

Background: Severe obesity among adolescent shows a worrisome trend in regard of its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index (BMI) with little perioperative complications. Despite the increasing utilization of BS, data is still insufficient, regarding their long-term outcome in adolescents. We review short and long-term effects of bariatric surgery and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. Summary: BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow up, shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. Key Messages: We conclude that obese adolescents without major obesity related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity related complications with proper pre-operative preparation and post operative follow up in excellence centers.


2019 ◽  
Vol 34 (10) ◽  
pp. 4626-4631
Author(s):  
Terri Menser ◽  
Jose Muniz Castro ◽  
Adriana Lopez ◽  
Stephen L. Jones ◽  
Bita A. Kash ◽  
...  

Abstract Introduction Following bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of these nutritional deficiencies based on two-year follow-up tests at recommended time points. Methods and procedures A retrospective data analysis was conducted of all laboratory tests for bariatric patients who underwent surgery between May 2016 and January 2018 with available lab data (n = 397). Results for nine different nutritional labs were categorized into six recommended postoperative time periods based on time elapsed since the procedure date. Binary variables were created for each laboratory result to calculate descriptive statistics of abnormalities for each lab test over time and used in the individual GEE logistic regression models. Grouped logistic regression examined the total nutritional deficiencies of the nine combined nutrients considering total available labs. Results Multiple lab tests indicated a very low frequency of abnormalities (e.g., Vitamin A, Vitamin B12, Copper, and Folate). Many of the nine included nutritional labs had an average deficiency of less than 10% across all time points. The grouped logistic model found preoperative nutritional deficiency to be predictive of postoperative nutritional deficiency (OR 3.70, p < 0.001). Conclusions We found the vast majority of routine lab test results to be normal at multiple time points. Current practice can add up to significant lab expenses over time. The frequency of postoperative testing in this population may be redundant and of very little value. Unnecessary follow-up laboratory testing costs the patients and the health care system in both time and resources. Patients with preoperative deficiencies appear to be at higher risk for nutritional deficiencies when compared to bariatric surgery patients that did not have preoperative nutritional deficiencies. Future research should focus on defining cost effective postoperative lab testing guidelines for at risk bariatric patients.


2015 ◽  
Vol 8 (1) ◽  
pp. 27 ◽  
Author(s):  
Mauro Akira Suizu ◽  
Romir Rodrigues ◽  
Juliana Isa Beraldo

A obesidade, doença crônica e complexa, acomete cada vez mais a população. Devido ao tratamento difícil, a cirurgia bariátrica, quando indicada, é eficiente, pois apresenta baixos riscos aos pacientes e boa manutenção da perda de peso. Entretanto, deve-se ter atenção no pós-operatório, devido aos efeitos colaterais promovidos pela cirurgia, resultando em modificações metabólicas e falhas nutricionais, decorrente da má absorção de nutrientes, dentre eles, o ferro. O objetivo da pesquisa foi avaliar a prevalência de anemia ferropriva no período de junho a outubro de 2013, com 32 pacientes submetidos à cirurgia bariátrica do tipo Y de Roux, pertencentes à Associação dos Obesos Operados Bariátricos de Paranavaí e Região (AOOB). Após realizarmos um comparativo parcial com os 32 bariátricos da comunidade, verificarmos deficiências nutricionais. Nos 32 pacientes da comunidade, 50% manifestaram anemia, com IMC 23,37 kg/m2 (21,41 ± 25,33) e idade média de 43 anos. Já na AOOB, 31,25% apresentaram anemia (com maior prevalência dois anos após a cirurgia), IMC 29,02 kg/m2 (24,80 ± 33,24) e idade média de 42,96 anos. Nos associados da AOOB, 46,87% possuem intolerância a carne vermelha; 65% usam suplementos nutricionais e a participação nas reuniões mensais variou de 113 a 32 presenças. Apesar do estudo ter revelado índices relevantes de anemia é essencial o acompanhamento pós-operatório, como o realizado pela AOOB, melhorando a qualidade de vida dos pacientes. No entanto, é necessário um estudo mais abrangente, com espaço amostral e período de tempo maior para solidificação das evidências aqui estudadas. Verification of Anemia in Patients with Bariatric Surgery (Roux-En-Y Gastric Bypass) Obesity, a chronic and complex disease, is more and more common in the population. Due to difficult treatment of obesity, bariatric surgery is efficient since it provides a good weight loss with few risks to patients. The post-operation period is important due to the side effects caused by metabolic modifications and nutritional flaws from a bad absorption of nutrients, especially iron. Current research, undertaken between June and October 2013, assesses the prevalence of iron-insufficiency anemia in 32 patients who underwent Roux-en-Y gastric bypass, belonging to the Association of Operated Obese People (AOOB) from the region of Paranavaí PR Brazil. Partial comparative exam with 32 bariatric patients showed nutritional deficiencies, or rather, 50% suffered from anemia, with BMI = 23.37 kg/m2 (21.41 ± 25.33) and average age 43 years, whereas in AOOB, 31.25% were anemic (after two years of surgery), IMC = 29.02 kg/m2 (24.80 ± 33.24) and mean age 42.96 years. Further, 46.87% of AOOB associates were non-tolerant to beef; 65% used nutrition supplements and participation in monthly meetings varied between 113 and 32. In spite of high anemia percentages, the post-operational follow-up is highly important since it improves the patients ́ lifestyle. However, a more comprising analysis is required with a bigger sample and a longer time span for the establishment of evidences.


2020 ◽  
Vol 78 (12) ◽  
pp. 1015-1029
Author(s):  
Robert Beaumont Wilson

Abstract Beriberi is a nutritional complication of gastric surgery, caused by deficiency of vitamin B1, or thiamine. Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death. This review describes the history and pathophysiology of beriberi as well as the relationship between beriberi and nutritional deficiencies after gastric surgery. A literature review of the history and pathophysiology of beriberi and the risk factors for thiamine deficiency, particularly after gastric resection or bariatric surgery, was performed. Recommendations for nutritional follow-up post gastric surgery are based on current national guidelines. Patients may have subclinical thiamine deficiency after upper gastrointestinal surgery, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake. This may occur very soon or many years after gastrectomy or bariatric surgery, even in apparently well-nourished patients. Prompt recognition and administration of supplemental thiamine can decrease morbidity and mortality in patients with beriberi. Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery.


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