Targeting FXR and FGF19 to Treat Metabolic Diseases—Lessons Learned From Bariatric Surgery

Molecular, genetic and epigenetic pathways of peroxynitrite-induced cellular toxicityOxidative stress plays a key role in the pathogenesis of cancer and many metabolic diseases; therefore, an effective antioxidant therapy would be of great importance in these circumstances. Nevertheless, convincing randomized clinical trials revealed that antioxidant supplementations were not associated with significant reduction in incidence of cancer, chronic diseases and all-cause mortality. As oxidation of essential molecules continues, it turns to nitro-oxidative stress because of the involvement of nitric oxide in pathogenesis processes. Peroxynitrite damages via several distinctive mechanisms; first, it has direct toxic effects on all biomolecules and causes lipid peroxidation, protein oxidation and DNA damage. The second mechanism involves the induction of several transcription factors leading to cytokine-induced chronic inflammation. Finally, it causes epigenetic perturbations that exaggerate nuclear factor kappa-B mediated inflammatory gene expression. Lessons-learned from the treatment of several chronic disorders including pulmonary diseases suggest that, chronic inflammation and glucocorticoid resistance are regulated by prolonged peroxynitrite production.

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Understanding bariatric surgery to support patients in primary care

Practice Nursing ◽

10.12968/pnur.2019.30.10.482 ◽

2019 ◽

Vol 30 (10) ◽

pp. 482-490

Author(s):

Jenny Abraham ◽

Neha Shah ◽

Fridi Levine ◽

Yitka Graham

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Metabolic Diseases ◽

Polycystic Ovary ◽

Signs And Symptoms ◽

World Health ◽

Alcoholic Fatty Liver ◽

Practice Nurses ◽

Excess Skin ◽

Nutritional Monitoring

The relatively new field of bariatric surgery is increasingly used as an option to address issues linked to obesity. Practice nurses must understand how they can manage patients who have undergone these procedures Obesity is steadily rising, with 64% of adults in England in 2017 being classified as overweight or obese. Obesity is strongly linked to metabolic diseases such as cardiovascular disease, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), musculoskeletal and respiratory disorders, cancer as well as psychological illness ( World Health Organization (WHO), 2018 ). Therefore every opportunity should be taken to support patients to lose weight and maintain weight loss. Practice nurses are in a unique and pivotal position to guide patients in a variety of options to assist in their weight loss. Bariatric surgery in England is relatively new, with its usage having increased dramatically in the last 10 years. Practice nurses require knowledge of bariatric surgery to undertake their role effectively. This article provides information to assist practice nurses in providing care and support to patients who have had a surgical intervention. This paper also highlights signs and symptoms of physical and psychological complications including pregnancy and excess skin and recommended action and advice including nutritional monitoring and supplementation.

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Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis

10.1093/med/9780190608347.003.0021 ◽

2018 ◽

Author(s):

Hideharu Shimizu ◽

Tomasz G. Rogula ◽

Philip R. Schauer

Keyword(s):

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Metabolic Diseases ◽

Bariatric Procedure ◽

Morbidly Obese ◽

Class A ◽

Bariatric Patients ◽

Pugh Class ◽

Cirrhotic Patients ◽

Perioperative Risks

Perioperative risks for morbidly obese patients with cirrhosis are significant, and surgeons should consider these risks carefully in deciding on the type of bariatric procedure to be performed. The benefits of bariatric surgery for cirrhotic patients include substantial weight loss, improvements in metabolic diseases, and potential regression of fibrosis, which can also increase their eligibility and candidacy for liver transplantation. There is currently a lack of strong evidence, but the restrictive bariatric procedures are the safest options for carefully selected patients with cirrhosis. Sleeve gastrectomy is likely the best bariatric procedure for obtaining good outcomes without a prohibitive complication rate or mortality for patients with compensated, Child-Pugh class A cirrhosis without portal hypertension. Roux-en-Y gastric bypass is also appropriate for patients who are not suitable for sleeve gastrectomy. Surgeons should be prepared in case they see bariatric patients with cirrhosis diagnosed preoperatively or intraoperatively.

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Development of Quality Indicators: Lessons Learned in Bariatric Surgery

The American Surgeon ◽

10.1177/000313480607201006 ◽

2006 ◽

Vol 72 (10) ◽

pp. 870-874 ◽

Cited By ~ 4

Author(s):

Melinda A. Maggard ◽

Marcia L. Mcgory ◽

Clifford Y. Ko

Keyword(s):

Bariatric Surgery ◽

Quality Assessment ◽

Quality Indicators ◽

Expert Opinion ◽

Optimal Number ◽

Lessons Learned ◽

Surgical Quality ◽

Process Indicators ◽

Improvement Programs ◽

Quality Improvement Programs

Quality indicators will likely be used in comprehensive surgical quality assessment and improvement programs. Quality indicators are the actions equated with good quality of care. As a case example, bariatric surgery quality indicators were developed using evidence in the literature combined with formal expert opinion validation. Qualitative analysis was performed to identify the critical thematic issues surrounding development of these surgical quality indicators. Researchers identified five major thematic categories during the development process. These included feasibility in medical records (availability, ease of abstraction, and cost), the number of indicators developed (optimal number), the lack of evidence in the literature (weight on expert opinion), structural versus process indicators, and linkage to outcomes (need to demonstrate that adherence to indicators is associated with better outcomes). This project, using bariatric surgery as an example, uncovered important issues that need to be addressed when developing quality assessment and quality improvement programs for evaluating surgical quality. As quality indicators will likely be developed and used increasingly, future projects in this regard will benefit from these lessons.

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SP5.1.3 Analysis of National Bariatric Surgery Related Clinical Incidents: Lessons Learned and a Proposed Safety Checklist for Bariatric Surgery

British Journal of Surgery ◽

10.1093/bjs/znab361.113 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Islam Omar ◽

Brijesh Madhok ◽

Chetan Parmar ◽

Omar Khan ◽

Michael Wilson ◽

...

Keyword(s):

Bariatric Surgery ◽

Significant Proportion ◽

Lessons Learned ◽

Learning System ◽

Left Behind ◽

High Severity ◽

Nasogastric Tubes ◽

The Uk ◽

Bariatric Surgery Worldwide ◽

Learning Points

Abstract Background Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the UK every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents. Methods We analyzed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. The authors used their experience to identify learning themes and design a safety checklist. Results We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.3% (N = 164), intraoperative 38.1% (N = 206), and postoperative accounted for 31.6% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively. The most commonly reported high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most commonly reported high severity theme was improper management of diabetes mellitus (35;6.5%). Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively. Conclusion We identified 58 specific themes of bariatric surgery-related clinical incidents. We proposed specific recommendations for each incidents theme in addition to a bariatric safety checklist to help improve the safety of bariatric surgery worldwide.

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Lessons Learned from a Randomized Controlled Trial of Bariatric Surgery versus Intensive Lifestyle Modification for Individuals with Type 2 Diabetes

Journal of Clinical Trials ◽

10.4172/2167-0870.1000156 ◽

2014 ◽

Vol 04 (02) ◽

Author(s):

Scott Ritter

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Randomized Controlled Trial ◽

Lifestyle Modification ◽

Controlled Trial ◽

Lessons Learned ◽

Randomized Controlled

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Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery

Journal of Obesity ◽

10.1155/2016/4390254 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 21

Author(s):

Olivier F. Noel ◽

Christopher D. Still ◽

George Argyropoulos ◽

Michael Edwards ◽

Glenn S. Gerhard

Keyword(s):

Bariatric Surgery ◽

Lipid Metabolism ◽

Bile Acids ◽

Metabolic Diseases ◽

Overweight And Obesity ◽

Farnesoid X Receptor ◽

Metabolic Effects ◽

The Novel ◽

Treatment Of Obesity ◽

Lipid Metabolism Genes

Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D) mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs) as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR) transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes.

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