Friday, July 22, 2016

Using Liraglutide in Combination with the Endobarrier

Over the past several years, four obesity drugs have gained FDA approval and become available for the treatment of obesity. These drugs are Qsymia, produced by Vivus, Belviq, produced by Arena, Contrave, produced by Orexigen and Saxenda (liraglutide), produced by Novo Nordisk. These drugs give bariatric service providers new options to use in the fight against obesity. Bariatric surgery procedures, including gastric bypass surgery, sleeve gastrectomy and the lap band, provide another set of tools that bariatric service providers may use. These tools also include endoscopic weight loss procedures. And combining one of these endoscopic tools with liraglutide to combat obesity is being investigated.

The endoscopic tool is the endobarrier. The  endobarrier is a malabsorptive endoscopic bariatric therapy (EBT) device. The device, produced by Lexington, MA based GI Dynamics, is a liner for a section of the small intestine. And similar to the gastric balloon, the endobarrier is inserted into the intestine endoscopically. The endobarrier is designed to act as a barrier between the food one eats and the intestinal walls. With the endobarrier inserted, food digestion is reduced in a fashion similar to gastric bypass surgery.

In a study consisting of 70 subjects, the endobarrier-plus-liraglutide group lost more weight than the endobarrier-alone group or the liraglutide-only group. Further, the endobarrier-plus-liraglutide group experienced the most reduction in HbA1c.

Combining bariatric surgical methods with obesity drugs is a natural progression in obesity treatment. One expert indicated that although surgery can be beneficial, the combination of surgery and medication can be even more beneficial.

And in another somewhat related small study, investigators found that weight gain after bariatric surgery was "significantly reduced after treatment with liraglutide." The researchers suggested that liraglutide may be a treatment for those persons who failed to lose much weight or who failed to maintain the weight loss.

We commonly view pharmacotherapy as a weight loss tool to be used in conjunction with diet and exercise. But the bariatric surgery-drug combination may be another feasible option. The combination could add to the obesity treatment arsenal.

Sunday, July 10, 2016

More on Bariatric Embolization

Ghrelin is sometimes known as the hunger hormone. Researchers believe that ghrelin tells our brain that we are hungry. Methods that reduce the ghrelin in our bodies may decrease our urge to eat, thus causing weight loss. In fact, sleeve gastrectomy, considered to be an effective weight loss surgery, achieves a large part of its success by removing about 85% or the stomach, where much of the ghrelin in our body is found. Other methods that may eliminate or reduce ghrelin include diet and a bariatric procedure called bariatric embolization.

Investigators have found that following a diet containing healthy carbohydrates such as whole grains, and getting enough sleep, might decrease the ghrelin in our body. And a minimally invasive method that can reduce the effects of ghrelin is embolization--specifically bariatric embolization.

In bariatric embolization, certain blood vessels to the stomach are blocked to decrease the ghrelin flow to the brain. In the procedure, a small catheter is inserted in the left gastric artery via the wrist or the groin. This artery supplies the upper part of the stomach. Tiny particles are then injected into the artery to impede the flow of blood and decrease the amount of ghrelin singling the brain.

In one study consisting of 20 participants with a BMI of 40 to 5, "Preliminary results show a decrease in appetite corresponding to lower levels of circulating blood levels of the hunger hormone. Patients have shown promising weight loss in the first month after the procedure and an average excess weight loss of roughly 10 percent at 3 months."

Weight loss practitioners should monitor this research so they can be prepared to take advantage of the weight loss tool if and when it materializes. As one researcher indicated, "embolization could potentially serve as an intermediate step between lifestyle changes and weight-loss drugs -- which have limited effects for severe obesity -- and gastric surgery."
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