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Overview on the endoscopic treatment for obesity:A review

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World Journal of Gastroenterology 2023年第40期29卷 5526-5542页

作者： Maheeba Abdulla Nafeesa Mohammed Jehad AlQamish Department of Internal Medicine Ibn Al Nafees HospitalManama 54533Bahrain Department of Intensive Care Unit Salmaniya Medical ComplexManama 5616Bahrain

Obesity rates have increased,and so has the need for more specific treatments.This trend has raised interest in non-surgical weight loss techniques that are novel,safe,and straightforward.Thus,the present review describes the endoscopic bariatric treatment for obesity,its most recent supporting data,the questions it raises,and its future directions.Various endoscopic bariatric therapies for weight reduction,such as intragastric balloons(IGBs),aspiration therapy(AT),small bowel endoscopy,endoscopic sleeve gastroplasty,endoluminal procedures,malabsorption endoscopic procedures,and methods of regulating gastric emptying,were explored through literature sourced from different databases.IGBs,AT,and small bowel endoscopy have short-term effects with a possibility of weight regain.Minor adverse events have occurred;however,all procedures reduce weight.Vomiting and nausea are common side effects,although serious complications have also been observed.

关键词： Overweight Gastric bypass malabsorption Intragastric balloons

Phytochemical malabsorption:clinical significance

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World Journal of Gastroenterology 1998年第6期4卷 14-15页

作者： Mark L Wahlqvist and Naiyana Wattanapenpaiboon

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ＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮＣＥＯＦＰＨＹＴＯＣＨＥＭＩＣＡＬＳＵｎｔｉｌｒｅｃｅｎｔｙｅａｒｓ，ｎｕｔｒｉｔｉｏｎｉｓｔｓｈａｖｅｆｏｃｕｓｅｄｐｒｉｍａｒｉｌｙｏｎｍａｃｒｏｎｕｔｒｉｅｎｔｓａｎｄｍｉｃｒｏｎｕｔｒｉｅｎｔｓｉｎｆｏｏｄ...

关键词： phytochemicals vitamins minerals gastrointestinal malabsorption

Four-sample lactose hydrogen breath test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea

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World Journal of Gastroenterology 2015年第24期21卷 7563-7570页

作者： Jian-Feng Yang Mark Fox Hua Chu Xia Zheng Yan-Qin Long Daniel Pohl Michael Fried Ning Dai Department of Gastroenterology The First People’s Hospital of Hangzhou Department of Gastroenterology Sir Run Run Shaw Hospital affiliated to College of Medicine Zhejiang University Division of Gastroen- terology and Hepatology University Hospital Zürich NIHR Nottingham Digestive Diseases Biomedical Research Unit Queen’s Medical Centre

AIM: To validate 4-sample lactose hydrogen breath testing(4SLHBT) compared to standard 13-sample LHBT in the clinical setting.METHODS: Irritable bowel syndrome patients with diarrhea(IBS-D) and healthy volunteers(HVs) were enrolled and received a 10 g, 20 g, or 40 g doselactose hydrogen breath test(LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h(13 measurements). The detection rates of lactose malabsorption(LM) and lactose intolerance(LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT.RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups(P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT(97%-100%, Kappa 0.815-0.942) with high sensitivity(90%-100%) and specificity(100%) at all three lactose doses in both groups.CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid test for assessment of LM and LI in clinical practice.

关键词： Lactose hydrogen breath test Diagnosis Lactose malabsorption Lactose intolerance Irritablebowel syndrome

Helicobacter pylori infection and drugs malabsorption

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World Journal of Gastroenterology 2014年第30期20卷 10331-10337页

作者： Edith Lahner Camilla Virili Maria Giulia Santaguida Bruno Annibale Marco Centanni Gastrointestinal Unit Department of Digestive and Liver Disease"Sapienza" University of Roma00189 RomaItaly Endocrinology Unit Department of Medico-Surgical Sciences and Biotechnologies"Sapienza" University of Roma04100 LatinaItaly

Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of orally administered drugs and Helicobacter pylori(H.pylori)infection has been proposed.Associations have been reported between poor bioavailability of l-thyroxine and l-dopa and H.pylori infection.According to the Maastricht Florence Consensus Report on the management of H.pylori infection,H.pylori treatment improves the bioavailability of both these drugs,whereas the direct clinical benefits to patients still await to be established.Less strong seems the association between H.pylori infection and other drugs malabsorption,such as delavirdine and ketoconazole.The exact mechanisms forming the basis of the relationship between H.pylori infection and impaired drugs absorption and/or bioavailability are not fully elucidated.H.pylori infection may trigger a chronic inflammation of the gastric mucosa,and impaired gastric acid secretion often follows.The reduction of acid secretion closely relates with the wideness and the severity of the damage and may affect drug absorption.This minireview focuses on the evidence of H.pylori infection associated with impaired drug absorption.

关键词： Drug malabsorption Helicobacter pylori gastritis G

Co-occurrence of carbohydrate malabsorption and primary epiploic appendagitis

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World Journal of Gastroenterology 2015年第35期21卷 10242-10245页

作者： Wolfgang J Schnedl Peter Kalmar Harald Mangge Robert Krause Sandra J Wallner-Liebmann Practice for General Internal Medicine Department of Radiology Medical University of Graz Clinical Institute for Medical and Chemical Laboratory Diagnosis MUG Coordinator BioTechMed GrazMedical University of Graz Department of Internal Medicine Medical University of Graz Institute of Pathophysiology Centre for Molecular MedicineMedical University of Graz

Unspecific abdominal complaints including bloating and irregular bowel movements may be caused by carbohydrate malabsorption syndromes, e.g., lactose and fructose malabsorption. These symptoms were investigated with hydrogen(H2) breath tests and correlated to carbohydrate malabsorption. During performing these H2-breath tests the patient presented with an acute, localized, non-migratory pain in the left lower abdominal quadrant. Primary epiploic appendagitis is a rare cause of abdominal acute or subacute complaints and diagnosis of primary epiploic appendagitis(PEA) is made when computed tomography reveals a characteristic lesion. We report on a patient with cooccurrence of lactose and fructose malabsorption, which was treated successfully with a diet free of culprit carbohydrates, with PEA recovering without medication or surgical treatment within few days. Since the abdominal unspecific symptoms had been present for months, they appeared not to be correlated to the acute localized abdominal pain, therefore we speculate on a random co-occurrence of combined carbohydrate malabsorption and PEA.

关键词： Carbohydrate malabsorption Fructose malabsorption

Lactose malabsorption and intolerance: What should be the best clinical management?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2012年第3期3卷 29-33页

作者： Paolo Usai-Satta Mariella Scarpa Francesco Oppia Francesco Cabras Gastroenterology Unit Brotzu Hospital

Lactose malabsorption (LM) is the incomplete hydrolysis of lactose due to lactase deficiency, which may occur as a primary disorder or secondary to other intestinal diseases. Primary adult-type hypolactasia is an autosomal recessive condition resulting from the physiological decline of lactase activity. Different methods have been used to diagnose LM. Lactose breath test represents the most reliable technique. A recent consensus conference has proposed the more physiological dosage of 25 g of lactose and a standardized procedure for breath testing. Recently a new genetic test, based on C/T13910 polymorphism, has been proposed for the diagnosis of adult-type hypolactasia, complementing the role of breath testing. LM represents a wellknown cause of abdominal symptoms although only some lactose malabsorbers are also intolerants. Diagnosing lactose intolerance is not straightforward. Many non-malabsorber subjects diagnose themselves as being lactose intolerant. Blind lactose challenge studies should be recommended to obtain objective results. Besides several studies indicate that subjects with lactose intolerance can ingest up to 15 g of lactose with no or minor symptoms. Therefore a therapeutic strategy consists of a lactose restricted diet avoiding the nutritional disadvantages of reduced calcium and vitamin intake. Various pharmacological options are also available. Unfortunately there is insufficient evidence that these therapies are effective. Further double-blind studies are needed to demonstrate treatment effectiveness in lactose intolerance.

关键词： Lactose malabsorption Lactose intolerance Therapeutic options

Diarrhea after bariatric procedures:Diagnosis and therapy

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World Journal of Gastroenterology 2017年第26期23卷 4689-4700页

作者： Yves M Borbély Alice Osterwalder Dino Kroll Philipp C Nett Roman A Inglin Clinic for Visceral Surgery and Medicine InselspitalBern University HospitalUniversity of Bern

Diarrhea after bariatric procedures, mainly those with malabsorptive elements including Roux-Y Gastric Bypass and Biliopancreatic Diversion, is common and an essential determinant of quality of life and microand macronutrient deficiencies. Bariatric surgery is the only sustainably successful method to address morbid obesity and its comorbidities, particularly gaining more and more importance in the specific treatment of diabetic patients. Approximately half a million procedures are annually performed around the world, with numbers expected to rise drastically in the near future. A multitude of factors exert their influence on bowel habits; preoperative comorbidities and procedure-related aspects are intertwined with postoperative nutritional habits. Diagnosis may be challenging owing to the characteristics of postbariatric surgery anatomy with hindered accessibility of excluded segments of the small bowel and restriction at the gastric level. Conventional testing measures, if available, generally yield low accuracy and are usually not validated in this specific population. Limited trials of empiric treatment are a practical alternative and oftentimes an indispensable part of the diagnostic process. This review provides an overview of causes for chronic post-bariatric surgery diarrhea and details the particularities of its diagnosis and treatment in this specific patient population. Topics of current interest such as the impact of gut microbiota and the influence of bile acids on morbid obesity and especially their role in diarrhea are highlighted in order to provide a better understanding of the specific problems and chances of future treatment in post-bariatric surgery patients.

关键词： Bariatric surgery Diarrhea Malnutrition malabsorption Steatorrhea Dumping syndrome Bile acids and salts Gut microbiota Blind loop syndrome

Less common etiologies of exocrine pancreatic insufficiency

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World Journal of Gastroenterology 2017年第39期23卷 7059-7076页

作者： Vikesh K Singh Mark E Haupt David E Geller Jerry A Hall Pedro M Quintana Diez Division of Gastroenterology Johns Hopkins University School of MedicineBaltimoreMD 21287United States Medical Affairs AbbVie Inc.North ChicagoIL 60064United States Cystic Fibrosis Clinical Development AbbVie Inc.North ChicagoIL 60064United States CREON^(█) Clinical Development AbbVie Inc.North ChicagoIL 60064United States CREON^(█) Development AbbVie Inc.North ChicagoIL 60064United States

Exocrine pancreatic insufficiency(EPI), an important cause of maldigestion and malabsorption, results from primary pancreatic diseases or secondarily impaired exocrine pancreatic function. Besides cystic fibrosis and chronic pancreatitis, the most common etiologies of EPI, other causes of EPI include unresectable pancreatic cancer, metabolic diseases(diabetes); impaired hormonal stimulation of exocrine pancreatic secretion by cholecystokinin(CCK); celiac or inflammatory bowel disease(IBD) due to loss of intestinal brush border proteins; and gastrointestinal surgery(asynchrony between motor and secretory functions, impaired enteropancreatic feedback, and inadequate mixing of pancreatic secretions with food). This paper reviews such conditions that have less straightforward associations with EPI and examines the role of pancreatic enzyme replacement therapy(PERT). Relevant literature was identified by database searches. Most patients with inoperable pancreatic cancer develop EPI(66%-92%). EPI occurs in patients with type 1(26%-57%) or type 2 diabetes(20%-36%) and is typically mild to moderate; by definition, all patients with type 3 c(pancreatogenic) diabetes have EPI. EPI occurs in untreated celiac disease(4%-80%), but typically resolves on a gluten-free diet. EPI manifests in patients with IBD(14%-74%) and up to 100% of gastrointestinal surgery patients(47%-100%; dependent on surgical site). With the paucity of published studies on PERT use for these conditions, recommendations for or against PERT use remain ambiguous. The authors conclude that there is an urgent need to conduct robust clinical studies to understand the validity and nature of associations between EPI and medical conditions beyond those with proven mechanisms, and examine the potential role for PERT.

关键词： Celiac disease Inflammatory bowel disease Exocrine pancreatic insufficiency malabsorption Epidemiology Pancreas Pancreatic cancer Secretion/absorption Surgery

Long-term outcome of pancreatic function following oncological surgery in children:Institutional experience and review of the literature

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World Journal of Clinical Cases 2021年第25期9卷 7340-7349页

作者： Giulia Bolasco Teresa Capriati Chiara Grimaldi Lidia Monti Maria Debora De Pasquale Ippolita Patrizia Patera Marco Spada Giuseppe Maggiore Antonella Diamanti Hepatology Gastroenterology and Nutrition Unit“Bambino Gesù”Children’s HospitalIRCCSRome 00165Italy Division of Hepatobiliopancreatic Surgery Liver and Kidney Transplantation"Bambino Gesù"Children's HospitalIRCCSRome 00165Italy Radiology Department "Bambino Gesù"Children’s HospitalIRCCSRome 00165Italy Hematology/Oncology Department "Bambino Gesu"Children's HospitalIRCCSRome 00165Italy Endocrinology and Diabetes Unit "Bambino Gesù"Children’s HospitalIRCCSRome 00165Italy

BACKGROUND Pancreatic neoplasms are uncommon in children and in most cases they are benign or have low malignant potential.Pancreatoblastoma and solid pseudopapillary tumor are the most frequent types in early and late childhood,respectively.Complete resection,although burdened by severe complications,is the only curative treatment for these diseases.Pancreatic surgery may result in impaired exocrine and endocrine pancreatic function.However,limited data are available on the long-term pediatric pancreatic function following surgical resection.AIM To investigate endocrine and exocrine pancreatic function and growth after oncological pancreatic surgery in a pediatric series.METHODS A retrospective analysis of all pediatric patients who underwent surgery for pancreatic neoplasm in our Institution from January 31,2002 to the present was performed.Endocrine and exocrine insufficiency,auxological and fat-soluble vitamin status(A,D,E and clotting tests)were assessed at diagnosis and at every follow-up visit.Exocrine insufficiency was defined as steatorrhea with fecal elastase-1<200μg/g stool,while endocrine insufficiency was identified as onset of Diabetes or Impaired Glucose Tolerance.Growth was evaluated based on body mass index(BMI)z-score trend.RESULTS Sixteen patients(12 girls and 4 boys,mean age 10.7±5.3 years),were included.Nine patients(56%)had a neoplasm in the pancreatic head,4 in the body/tail,2 in the tail and 1 in the body.Histological findings were as follows:Solid pseudopapillary tumor in 10 patients(62.5%),insulinoma in 2 patients,neuroendocrine tumor in 2 patients and acinar cell carcinoma in 2 patients.The most frequent surgery was pancreaticoduodenectomy(50%).Exocrine failure occurred in 4 patients(25%)and endocrine failure in 2 patients(12.5%).Exocrine insufficiency occurred early(within 6 mo after surgery)and endocrine insufficiency later(8 and 10 years after surgery).Mean BMI z-score was 0.36±1.1 at diagnosis and 0.27±0.95 at the last assessment.Vitamin D was insufficient(<30 ng/mL)in 8 of the 16 p

关键词： Pancreatic neoplasms Pancreatic function Children malabsorption Pancreatic failure Growth