scholarly journals The Role of the Small Bowel in Unintentional Weight Loss after Treatment of Upper Gastrointestinal Cancers

2019 ◽  
Vol 8 (7) ◽  
pp. 942 ◽  
Author(s):  
Dehestani ◽  
le Roux
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Small Bowel ◽  
Cancer Cachexia ◽  
Treatment Modalities ◽  
Unintentional Weight Loss ◽  
Upper Gi ◽  
Gi Cancers ◽  
Upper Gastrointestinal

Upper gastrointestinal (GI) cancers are responsible for significant mortality and morbidity worldwide. To date, most of the studies focused on the treatments’ efficacy and post-treatment survival rate. As treatments improve, more patients survive long term, and thus the accompanying complications including unintentional weight loss are becoming more important. Unintentional weight loss is defined as >5% of body weight loss within 6–12 months. Malignancies, particularly GI cancers, are diagnosed in approximately 25% of patients who present with unintentional weight loss. Whereas some recent studies discuss pathophysiological mechanisms and new promising therapies of cancer cachexia, there is a lack of studies regarding the underlying mechanism of unintentional weight loss in patients who are tumor free and where cancer cachexia has been excluded. The small bowel is a central hub in metabolic regulation, energy homeostasis, and body weight control throughout the microbiota-gut-brain axis. In this narrative review article, the authors discussed the impacts of upper GI cancers’ treatment modalities on the small bowel which may lead to unintentional weight loss and some new promising therapeutic agents to treat unintentional weight loss in long term survivors after upper GI operations with curative intent.

scholarly journals A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ken Kurisu ◽  
Yukari Yamanaka ◽  
Tadahiro Yamazaki ◽  
Ryo Yoneda ◽  
Makoto Otani ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Rare Complication ◽  
Nutrition Therapy ◽  
Psychological Status ◽  
Sma Syndrome

Abstract Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

scholarly journals Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Miral Subhani ◽  
Kaleem Rizvon ◽  
Paul Mustacchia
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Drug Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Comorbid Conditions ◽  
Endoscopic Evaluation ◽  
Number Of Patients ◽  
Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

Esophageal Diameters in Children Correlated to Body Weight

2018 ◽  
Vol 29 (06) ◽  
pp. 528-532
Author(s):  
Thomas Sebastian Bott ◽  
Thekla von Kalle ◽  
Alexander Schilling ◽  
Oliver Heinz Diez ◽  
Sarah Besch ◽  
...  
Keyword(s):  
Body Weight ◽  
Pediatric Surgery ◽  
The Body ◽  
Lateral Aspect ◽  
Arithmetic Average ◽  
Upper Gi ◽  
Time Period ◽  
Upper Gastrointestinal ◽  
Weight Groups ◽  
Weight Percentile

Introduction The development of stenoses after correction of an esophageal atresia or acid and lye burn of the esophagus are well-known problems in pediatric surgery. Currently, stenoses are treated in the majority of cases by repeated balloon dilatations. The diameter of the balloons used is not standardized; standard curves do not exist. The aim of this study was to evaluate the diameter of the esophagus correlated to the body weight of the children as measured in upper gastrointestinal (GI) studies to answer the important question to what extent a stenosis should be dilated. Materials and Methods Within the time period from 2011 through 2016, 60 patients with upper GI studies were selected. Evaluations were blinded to two different examiners. The diameters were measured under maximum contrast filling between the second and third rib (cranial point of measurement) and between the seventh and eighth rib (caudal point of measurement). For both, the anteroposterior and lateral aspect was examined. The diameter was calculated as the arithmetic average of both measurements within one level. The diameters were correlated to the weight of the children. Results All children (n = 38) within the 3rd to 97th weight percentile were analyzed. Linear correlation and coefficients of 0.67 at the cranial point and 0.70 at the caudal point were found. Mean diameter at the cranial point of measurement was 6.75 mm at the lowest weight (2.6 kg) and 14 mm at 74 kg. Mean weight of these children (standard deviation [SD]) was 25.3 (18.8) kg and median age was 7 years. Within weight groups (0–10 kg; 10–20 kg; 20–35 kg; 35–50 kg; >50 kg), we calculated SD and two side tested critical 95% confidence interval for all measurements (n = 74). Conclusion Although the variation in measurements is considerable, this evaluation gives a reliable hint to which extent esophageal stenoses should be dilated in relation to the body weight. To the best of our knowledge, this is the first investigation to evaluate the diameter of the esophagus in children in relation to the body weight.

scholarly journals MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Flavio Cadegiani
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Body Weight ◽  
Weight Regain ◽  
Morbidly Obese ◽  
Biochemical Profile ◽  
Initial Weight ◽  
Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of >20% loss of the initial BW loss, and no weight regain (or < 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p < 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

scholarly journals Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients

1970 ◽  
Vol 8 (1) ◽  
pp. 25-28 ◽  
Author(s):  
VN Ravikumar ◽  
K Rudresh ◽  
U Jalihal ◽  
R Satish ◽  
R Manjunath
Keyword(s):  
Weight Loss ◽  
Epigastric Pain ◽  
Cd4 Count ◽  
Common Finding ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Mucosal Involvement ◽  
The Mean ◽  
Upper Gastrointestinal ◽  
Oesophageal Candidiasis

Background: Human Immunodeficiency Virus (HIV) infected patient frequently report upper gastrointestinal (GI) symptoms; however their prevalence and diagnostic approach is not well known. Objective: The objective of this study was to study clinical, endoscopic and histopathological changes in HIV infected patients with upper GI symptoms and their correlation with CD4 count. Materials and methods: We evaluated 50 HIV infected patients who presented to M.S. Ramaiah hospital with upper GI symptoms. All patients answered questionnaire assessing upper GI symptoms and underwent upper GI endoscopy. Mucosal biopsy was taken wherever mucosal abnormality seen. Results: In our study, the mean age of patients was 40.98 yrs, of which 80% were males. Vomiting (36%), epigastric pain (36 %), weight loss (34 %) and anorexia (34%) were the predominant symptoms. Esophagogastroduodenoscopy (EGD) findings revealed- Oesophageal candidiasis in 28.0%, esophagitis in 22.0%, gastritis in 20.0 %, duodenitis in 14 %, normal upper GI mucosa in 18 % patients. Oesophageal candidiasis was the most common finding on histopathological examination and the mean CD4 count was 157.92 cells/μl. Conclusion: Vomiting, epigastric pain, weight loss and anorexia were most frequent symptoms. Oral candidiasis was the most common oral lesion. Oesophageal candidiasis, oesophagitis and oesophageal ulcers were the common findings on EGD. Patient with CD4 count less than 200cells/μl had more frequent upper GI mucosal involvement than in patients with CD4 count more than 200. Majority of the patients with GI symptoms had upper GI mucosal changes and opportunistic infections. Thus endoscopic and histopathological evaluation is advisable for the early diagnosis and treatment of upper GI complications in patients with HIV infection. Key words: AIDS; Oesophageal candidiasis; Esophagogastroduodenoscopy; HIV; Upper gastrointestinal symptoms. DOI: 10.3126/kumj.v8i1.3217 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 25-28

Unintentional weight loss

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Muscle Mass ◽  
Underlying Disease ◽  
Nutritional Intake ◽  
Calorie Intake ◽  
Activity Levels ◽  
Unintentional Weight Loss ◽  
Fat Stores ◽  
Underlying Pathology

Body weight is determined by the combination of metabolic rate, calorie intake, and activity levels. Natural weight loss is usually due to declining muscle mass, with the redistribution of muscle mass in the extremities, leading to greater truncal fat stores. Unintentional weight loss refers to weight loss that is not voluntary, and can reflect serious underlying pathology. It can be caused by inadequate nutritional intake, increased metabolism, malabsorption, or a combination of these factors. Weight loss of 5% of body weight over 6–12 months should be investigated. Cachexia is a complex syndrome in which loss of body mass (fat and protein) cannot be reversed nutritionally, that is, is due to underlying disease processes inducing catabolism, rather than to inadequate nutritional intake.

scholarly journals Bone Mineral Density and Fracture Risk in Obese Older Adults 12 Months After Completion of a 6-Month Higher Protein Diet and Exercise Intervention

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 67-67
Author(s):  
Kathryn Porter Starr ◽  
Michael Borack ◽  
Kenneth Lyles ◽  
Marshall Miller ◽  
Jamie Rincker ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Older Adults ◽  
Weight Loss ◽  
Body Weight ◽  
Fracture Risk ◽  
G Protein ◽  
Bone Mineral ◽  
Protein Diet ◽  
Mineral Density

Abstract Objectives Weight loss interventions for older adults often reduce bone mineral density (BMD), increasing risk of subsequent detrimental outcomes. This study explored the long-term impact of a higher protein diet plus exercise versus a diet plus exercise control treatment on body weight, bone mineral density at 3 sites, and fracture risk. Methods Obese (BMI 34.3 ± 4.7 kg/m2) older adults (n = 55; age = 70.0 ± 6.1 yrs) with Short Physical Performance Battery (SPPB) score = 9.2 ± 1.4 (out of 12) who completed a 6-month weight loss plus exercise trial were invited to return for assessment 12 months later. The original randomization was to either 0.8 g protein/kg body weight (Control) or 1.2 g protein/kg body weight, predominantly dairy (Protein). The 18-month assessment included BMD by DEXA (Hologic, Horizon model A) for femoral neck (FN), total hip (TH), and spine (lumbar vertebrae 1–4; LS), as well body weight and secondary outcomes for Fracture Risk Assessment Tool (FRAX). Results A total of 38 (69.1%) study completers were assessed at 18 mo. Body weight was lower than baseline for both Control and Protein (P < 0.01), with Control (−4.8%) trending towards better maintenance of weight loss vs Protein (−2.3%) (P = 0.06). BMD at 18 mo. was not different from baseline in both Control and Protein for LS (0.01 ± 0.05 g/cm2 and −0.0002 ± 0.05 g/cm2; P = 0.512), FN (−0.01 ± 0.07 g/cm2 and −.009 ± 0.04 g/cm2; P = 0.814) and TH (−0.012 ± 0.03 g/cm2 and −.008 ± 0.033 g/cm2; P = 0.685). Change in BMD at 18 mo. did not differ by group at any site; the previously reported Protein group increase in LS at 6 mo. was not sustained. For individual fracture risk, between 0 and 18 mo., 6 improved (5 osteopenia to normal, 1 osteoporosis to osteopenia) and 1 worsened (normal to osteopenia but FRAX score below total and hip fracture thresholds). Conclusions The finding that obese older adults can maintain a lower body weight for 12 months without a decline in BMD and no increase in fracture risk amplifies our previous findings of legacy benefits of a short term obesity intervention for older adults. Further study is needed to determine if the protein benefit to LS is sustained if the higher protein intake is continued long term. Funding Sources This study was funded by the National Dairy Council and the US Department of Veterans Affairs Rehabilitation Research and Development Program.

scholarly journals Skeletal Muscle Fibrosis in Pancreatic Cancer Patients with Respect to Survival

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Sarah M Judge ◽  
Rachel L Nosacka ◽  
Daniel Delitto ◽  
Michael H Gerber ◽  
Miles E Cameron ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Weight Loss ◽  
Body Weight ◽  
Cellular Response ◽  
Cancer Cachexia ◽  
Cancer Control ◽  
Body Weight Loss ◽  
Collagen Content ◽  
Calcium Deposition ◽  
Control Subjects

Abstract Background Cancer cachexia is a catabolic condition characterized by skeletal muscle wasting, consequent to tumor burden, which negatively impacts tolerance to cancer therapies and contributes to increased mortality. Partly because of the limited knowledge of the underlying mechanisms of cancer cachexia derived from human studies, however, the ability to therapeutically intervene remains elusive. The purpose of the current study was therefore to better define the phenotype of skeletal muscle obtained from patients with pancreatic ductal adenocarcinoma (PDAC), which has one of the highest rates of cachexia. Methods Morphological analyses were performed on rectus abdominis muscle biopsies obtained from resectable PDAC patients undergoing tumor resection surgery (N = 20) and from weight-stable non-cancer control subjects undergoing benign abdominal surgery (N = 16). PDAC patients with a body weight loss of greater than 5% during the previous 6 months were considered cachectic (N = 15). Statistical tests were two sided. Results Skeletal muscle from cachectic PDAC patients had increased collagen content compared with non-cancer control subjects (1.43% vs 9.66%, P = .0004, Dunn test). Across all PDAC patients, collagen content positively correlated with body weight loss (P = .0016, r = 0.672), was increased in patients with lymph node metastasis (P = .007, Mann-Whitney U test), and was associated with survival on univariate (HR = 1.08, 95% confidence interval [CI] = 1.02 to 1.04, P = .008) and multivariable analyses (HR = 1.08, 95% CI = 1.00 to 1.17, P = .038). Cachectic PDAC patients also displayed increased lipid deposition (2.63% vs 5.72%, P = .042), infiltration of CD68+ macrophages (63.6 cells/mm2 vs 233.8 cells/mm2, P = .0238), calcium deposition (0.21% vs 2.51%, P = .030), and evidence of deficient cellular quality control mechanisms (Mann-Whitney U test). Transcriptional profiling of all patients supported these findings by identifying gene clusters related to wounding, inflammation, and cellular response to TGF-β upregulated in cachectic PDAC patients compared with non-cancer control subjects. Conclusions To our knowledge, this work is the first to demonstrate increased collagen content in cachectic PDAC patients that is associated with poor survival.

Can self-reported body weight be used to evaluate long-term follow-up of a weight-loss program?

1987 ◽  
Vol 87 (9) ◽  
pp. 1198-1201 ◽  
Author(s):  
Grethe S. Tell ◽  
Robert W. Jeffery ◽  
F. Matthew Kramer ◽  
Mary Kaye Snell
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Weight Loss Program ◽  
Long Term Follow Up
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