Saturday, July 27, 2019

Laparoscopic Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes

Today, more and more U.S. citizens are  experiencing obesity and type 2 diabetes. Furthermore, obesity and type 2 diabetes among children are also at high levels. Usually, bariatric surgery is used to treat obesity. But some forms of bariatric surgery are being viewed as a viable treatment for type 2 diabetes. Two frequently used bariatric surgery methods in use today, for weight loss, are laparoscopic roux-en-y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG). And both of these surgical methods are also considered to be viable treatments for type 2 diabetes. But one study suggests that gastric bypass surgery may be the most effective treatment, in general, for obesity and type 2 diabetes.

RYGB and LSG are similar in one respect: both surgeries "modify the upper gastrointestinal tract anatomy." And this characteristic appears to make gastric bypass and sleeve gastrectomy more effective at weight loss and type 2 diabetes management than other forms of bariatric surgery.
However, a recent study shows that gastric bypass surgery may be the best choice in most cases. The study was a meta-analysis consisting of 16 randomized controlled trials. Eleven hundred thirty-two overweight or obese patients were included in the analysis.

The investigators concluded that "RYGB is more effective than SG in improving weight loss and short- and mid-term glycaemic and lipid metabolism control in patients with and without T2DM. Therefore, unless contraindicated, RYGB should be the first choice to treat patients with obesity and T2DM ..."

Of course there may be contraindications and other potential issues to consider when deciding on the appropriate surgery. For example, the possibility of reintervention should be kept in mind. One study showed that "[LSG] has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up."

Indeed, "the long-term safety profile of LSG compared with RYGB should be an essential part of the discussion in patient-centered decision making when choosing between bariatric procedure options." And under the right conditions, LSG could be the best choice. 

Monday, July 22, 2019

Obesity, Inflammation and Cancer

When our body is infected, our body's immune system fights the infection. While fighting the infected area, our body will often cause the affected area to become inflamed. And under normal conditions, once the infection is over, and the immune system no longer needs to fight the infection, the inflammation will subside. But when the inflammation lasts too long, it can cause problems in our bodies. Overweight and obesity can cause inflammation in the body. And if the overweight or obesity is long term, they may cause long term, harmful, inflammation. Further, this inflammation can lead to serious diseases, including colorectal cancer.

Too much inflammation creates a condition in which the "immune response has not been turned off so your immune system is running out of control, releasing pro-inflammatory immune cells when they’re not needed anymore." Pro-inflammatory proteins, called cytokines, are associated with these cells. These cytokines are also associated with fat cells. So with an abundance of fat cells, there can be an increase in pro-inflammatory cytokines. And a recent study has shown that this increase in pro-inflammatory cytokines can lead to colorectal cancer.

The study was done at Tufts University. One of the investigators indicated that their study 'results establish, for the first time, that concentrations in the colon of two major cytokines increase in concert with increasing BMI in humans. The increased concentrations are accompanied by changes in gene activation within the lining of the colon that are pro-cancerous in nature.'

Overweight and obese persons can suffer from a number of unhealthy conditions. And many of the conditions may be linked to inflammation. One of these conditions is colorectal cancer.

As we learn more about the link between inflammation and cancer, therapies can be devised to target the inflammation. But one thing is obvious: treating overweight and obesity should be an ongoing endeavor, since there is a link between overweight or obesity and inflammation.
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