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 macro...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.展开更多
AIM:Gallstone disease is increasing in sub-saharan Africa (SSA).In the west, the majority of stones can be dissolved with bile salts,since the major component is cholesterol.This medical therapy is expensive and not r...AIM:Gallstone disease is increasing in sub-saharan Africa (SSA).In the west, the majority of stones can be dissolved with bile salts,since the major component is cholesterol.This medical therapy is expensive and not readily accessible to poor populations of SSA.It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients,so as to make the case for introducing bile salt therapy in SSA.METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis.Data on age, sex, serum cholesterol,and thepercentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a preestablished proforma. Frequencies of the major components of the stones were determined.RESULTS:Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study.The majority of patients (65.38%) had stones with less than 25% of cholesterol.Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively.CONCLUSION:Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.展开更多
文摘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.
文摘AIM:Gallstone disease is increasing in sub-saharan Africa (SSA).In the west, the majority of stones can be dissolved with bile salts,since the major component is cholesterol.This medical therapy is expensive and not readily accessible to poor populations of SSA.It was therefore necessary to analyze the chemical composition of biliary stones in a group of patients,so as to make the case for introducing bile salt therapy in SSA.METHODS: All patients with symptomatic gallstones were recruited in the study. All stones removed during cholecystectomy were sent to Houston for x-ray diffraction analysis.Data on age, sex, serum cholesterol,and thepercentage by weight of cholesterol, calcium carbonate, and amorphous material in each stone was entered into a preestablished proforma. Frequencies of the major components of the stones were determined.RESULTS:Sixteen women and ten men aged between 27 and 73 (mean 44.9) years provided stones for the study.The majority of patients (65.38%) had stones with less than 25% of cholesterol.Amorphous material made up more than 50% and 100% of stones from 16 (61.53%) and 9 (34.61%) patients respectively.CONCLUSION:Cholesterol is present in small amounts in a minority of gallstones in Yaounde. Dissolution of gallstones with bile salts is unlikely to be successful.
