Table 1 Characteristics of the 520 severely obese patients before and 6 months after bariatric surgery   Before After LAGB (n = 149) LMGB (n = 371) p value LAGB (n = 149) LMGB (n = 371) p value Age (mean ± SD) 31.9 ± 9.2 30. 7 ± 8.3 0.23 – – – Male/female 66/83 105/266 <0.01 – –   Systolic blood pressure (mmHg) 136.5 ± 20.5 134.0 ± 17.6 0.18 143.8 ± 25.8 129.2 ± 19.9 <0.01 Diastolic blood pressure (mmHg) 86.6 ± 13.4 86.0 ± 12.9 0.65 87.3 ± 24.2 75.8 ± 13.2 <0.01 HbA1c (%) 7.2 ± 1.1 7.0 ± 1.0 0.10 6.6 ± 0.6 6.1 ± 0.6 0.10 Hemoglobin (g/dl) 14.3 ± 1.7 14.0 ± 1.6 0.27 14.9 ± 1.6 14.8 ± 1.8 0.49 Blood glucose (mg/dl) 149.7 ± 65.5 149.5 ± 44.9 0.51 119.5 ± 16.1 113.5 ± 9.4 0.06 BMI (kg/m2) 41.9 ± 6.3 42.0 ± 6.2 0.87 35.1 ± 6.5 31.3 ± 4.8 0.01 Read more at www.springerlink.com

Barrett Esophagus: Are We Screening Too Often?

David A. Johnson, MD

Hello. I am Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School. Surveillance and diagnosis are part of the mainstay of evaluation for Barrett’s esophagus (BE) in patients with reflux disease. This has been predicated on knowing that BE is a precancerous condition associated with progression to cancer at an estimated incidence of 0.4%-0.5% per year, and to high-grade dysplasia at 0.9% per year. The incidence that we quote to patients is 1.5% yearly progression to high-grade dysplasia cancer. Those studies were done some time ago, and 2 new, very large epidemiologic studies are changing the waterfront of BE. One was published in the Journal of the National Cancer Institute [1] in July; this study came from Ireland. It was a very large database, including all patients with BE, capturing data from more than 8000 patients. The mean duration of follow-up was 7 years (range: 1-20 years). The de novo progression to cancer from BE (excluding incident cancers) at 1 year was 0.13%. This incidence is very low and very different from 0.4%-0.5% per year, which had estimated the risk to be 30-40 times that of the general population. The risk is now down to 10-11 times the risk in the general population. The most recent study, published in The New England Journal of Medicine [2] in October, shows essentially the same information, this time coming from a study in Denmark that included all patients with BE, and excluded cancer found within the first year after diagnosis. The mean follow-up was 6 years, and the rate of progression to cancer was 0.12% per year. Progression to cancer was 3 times more common in men than women. The risk in women was inordinately low. Let me put this in perspective for you. If you look at cost modeling studies that have been done in the past (one that comes to mind is from 2003 in the Annals of Internal Medicine [3]) they found that screening or surveillance of BE was effective from a cost standpoint, at 5-year intervals if the incident cancer risk was ≥ 1.9% per year. At 1.9%, we are talking about 4 times the rates that are being reported now. The incident rate is considerably lower than 0.1%-0.13%, the rate at which it was cost-effective to screen at 5-year intervals. The current guidelines recommend 3-year follow-up for BE. This raises the question: is it cost-effective at the present time, when, because of dollar restrictions we are tossing out things like Pap smears and prostate-specific antigen tests? Surveillance in BE is certainly now subject to cost evaluation. Throw in the most recent study that comes from a Dr. Wani and colleagues,[4] a 5-site multicenter study that looked at the progression from low-grade dysplasia to cancer. Data were analyzed for 210 patients, and specimens were reviewed by centralized pathologists. The progression rate from low-grade dysplasia to esophageal adenocarcinoma (with a follow-up of 6 years) was 0.44% per year. In progression to cancer risk, this group did not differ from patients who had no low-grade dysplasia at study entry. The study also reiterated that there is terrible concordance for agreement on low-grade dysplasia. The kappa value was 0.14, which indicates poor agreement. Intra-observer variability was very high. This study raises red flags about the paradigm of 6-month evaluations for patients with low-grade dysplasia. No cancers were evident in the low-grade dysplasia patients within 2 years of the diagnosis of low-grade dysplasia, so it also raises the question, could we potentially lengthen out the surveillance of low-grade dysplasia patients to longer intervals? We return to the bottom line. In the present day, no data suggest that patients with BE die at a higher rate than patients without BE. No data say that patients with BE under surveillance die at a lower rate than patients without surveillance. Even for esophageal adenocarcinomas, the risk for death doesn’t seem to be higher in patients with BE under surveillance strategies. The take-home message is that we need to re-evaluate the evaluation of risk in BE, and guideline committees need to incorporate these data, recognizing that these data are all European, and the biopsy protocols are different in Europe. The definition of intestinal dysplasia is not requisite for the diagnosis of BE in Europe as it is in the United States. These data raise a number of important questions about the relative risk for patients with BE. Do they need surveillance if they don’t have dysplasia? Do patients with dysplasia need surveillance at lengthened intervals? These findings suggest that we should not be ablating patients with low-grade dysplasia or metaplasia outside of research protocols. Certainly in clinical practice, I don’t think that should be the standard of care, nor would it be justifiable in the present day based on the cost evaluation and the relative risks for these patients. There is a lot on the plate for discussion. BE guidelines committees should convene in a more rapid fashion and reassess the relative risk, and provide guidance so we can achieve cost-effective medicine for our patients with BE. So, let’s pause, take a step back, and look at BE with a lot less concern than we used to. There is no question that BE is a precancerous condition and that it is associated with adenocarcinoma of the esophagus. As the biologic behavior of BE has become better understood, the relative clinical significance has dwindled. In your next conversation with your patients with BE, put this into perspective and evaluate the strategies for surveillance. Hopefully, the guidelines will also provide us with some meaningful changes in the not-too-distant future. I’m Dr. David Johnson. Thanks again for listening. Read more at www.medscape.com

Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews.

J Affect Disord.  2011; 133(1-2):61-8 (ISSN: 1573-2517)

de Zwaan M; Enderle J; Wagner S; Mühlhans B; Ditzen B; Gefeller O; Mitchell JE; Müller A Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nuremberg, Erlangen, Germany. martina.dezwaan@uk-erlangen.de

BACKGROUND: Candidates for bariatric surgery frequently have co-morbid psychiatric problems.

METHODS: This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months.

RESULTS: The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point.

LIMITATIONS: Missing data, limited statistical power, self-reported height and weight are the limitations of this study.

CONCLUSIONS: As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention. Read more at reference.medscape.com

Low-Sugar Diet Can Reduce Irritable Bowel Symptoms

Sandra Yin

November 2, 2011 (National Harbor/Washington, DC) — A diet that is low in certain natural sugars can reduce symptoms in patients with certain gut disorders, including irritable bowel syndrome (IBS). That is the message that Peter Gibson, MD, head of the Eastern Clinical School at Monash University in Victoria, Australia, shared at this year’s American Journal of Gastroenterology lecture here at American College of Gastroenterology 2011 Annual Scientific Meeting and Postgraduate Course.

His talk — Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms — addressed how certain food components can induce or trigger functional gut symptoms, and examined how avoiding those food components can lead to a global improvement in symptoms in patients with functional bowel disorders, including IBS.

If we can recognize what dietary components contribute to problems and reduce their intake, hypothetically, that should reduce symptoms, Dr. Gibson told the packed audience.

Dr. Gibson, who is a proponent and cofounder of a low-FODMAP diet, claims that poorly absorbed short-chain carbohydrates, which are small molecules that are potentially osmotically active and rapidly fermentable, are to blame for gut symptoms such as bloating, wind, abdominal pain, and changes in bowel habits.

FODMAP stands for fermentable, oligosaccharides (including the fructo-oligosaccharides found in wheat, rye, onion, garlic, leeks, and artichokes, and the galacto-oligosaccharides found in beans, chick peas, and lentils), disaccharides (milk products except hard cheese), monosaccharides (excess fructose, fruits that contain more fructose than glucose, honey, apples, pears, mangos, high-fructose corn syrup), and polyols (sugar alcohols including sorbitol, mannitol, stone fruits, apples and pears, mushrooms, cauliflower, snow peas, maltitol, and xylitol).

A number of studies have established the benefits of a low-FODMAP diet for certain patients, Dr. Gibson said. In one study, after just 2 days, patients with IBS who were placed on a high-FODMAP diet experienced increased abdominal pain, bloating, and tiredness.

In another study, patients randomized to a low-FODMAP diet, as opposed to a standard diet, for IBS experienced a marked improvement in symptoms overall. Read more at www.medscape.com

American College of Gastroenterology (ACG) 2011 Annual Scientific Meeting and Postgraduate Course

Stool Transplants Stop 90% of C difficile Recurrences

Sandra Yin

November 1, 2011 (National Harbor, Maryland/Washington, DC) — Multiple courses of standard antibiotic treatment often fail in patients with recurrent Clostridium difficile infections (CDIs), with recurrence rates reaching 50%. But a study presented here at the American College of Gastroenterology (ACG) 2011 Annual Scientific Meeting and Postgraduate Course pointed to a highly successful alternative.

Fecal microbiota transplants (FMTs), also known as stool transplants, succeeded in 91% of patients with recurrent CDI who had undergone 2 or more failed courses of treatment, including alternative antibiotics, pulse and tapered vancomycin, and probiotics, according to Mark Mellow, MD, director of the Digestive Health Center at INTEGRIS Baptist Medical Center in Oklahoma City, who was the study’s lead author.

“I think we have clearly shown that [FMT] is an effective treatment for patients who have had 2 or more previous episodes of C difficile infection, that it seems to be quite safe in the short term and in the relatively long term, and it’s really long lasting,” Dr. Mark Mellow told Medscape Medical News.

No patient developed recurrent CDI after the transplant without subsequently taking antibiotics. The transplants were not as successful in people who had to take antibiotics for some other infection.

Despite having CDI for an average of 11 months on average, the patients responded to the stool transplant in just 6 days. None of the patients developed recurrent CDI without subsequently taking antibiotics during follow-up. During the long-term follow-up, 30 patients took antibiotics for other infections; CDI recurred in 8 (27%) of those patients but none of the other patients.

In other findings, the average durations to resolution and improvement in diarrhea and fatigue were 6 days and 4 weeks, respectively.

The study involved 77 mostly elderly, debilitated patients who had a colonoscopic FMT for recurrent CDI. Patients completed a 36-item survey via mail or by phone at least 3 months after their fecal transplant. Treatment failure was defined as continued CDI or recurrence within 3 months of FMT. The average follow-up time after FMT was 17 months.

Patients who underwent colonoscopic FMT found it so effective that more than half (53%) said that a fecal microbiota transplant would be their top choice if they contracted CDI again.

Dr. Mellow called on physicians and lay people to think of stool as more than “just a smelly inert substance.” It is also a biologically active substance that secretes material capable of killing pathogens, he said. Read more at www.medscape.com

Surg Obes Relat Dis. 2011 Jun 24. [Epub ahead of print] Incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management. Kalaiselvan R, Exarchos G, Hamza N, Ammori BJ. Source Salford Royal Hospital, Salford, United Kingdom. Abstract BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is a well-established procedure to treat morbid obesity. Gastrojejunal anastomotic (GJA) ulcers can develop after surgery with subsequent perforation. Our aim was to evaluate the incidence, presentation and outcome of management of perforated GJA ulcer disease after laparoscopic RYGB. METHODS: The database of all patients at the senior author’s bariatric institutions was retrospectively reviewed. The results are presented as mean (range). RESULTS: From April 2002 to April 2010, 1213 patients underwent laparoscopic RYGB, which included 1184 primary and 29 revision procedures. The operative mortality was .15%. Ten patients developed perforated GJA ulcers (.82%) at a mean of 13.5 (6-19) months. The patients who presented to bariatric surgeons (n = 5) were treated with laparoscopic closure and an omental patch, and those who presented to nonbariatric surgeons (n = 5) were treated with laparotomy. The morbidity and mortality rate was 30% and 10%, respectively, and the mean postoperative hospital stay for the survivors was 14 (5-44) days. CONCLUSION: Perforated GJA ulcers can develop in 1 of 120 patients after laparoscopic RYGB and can be effectively managed by laparoscopic repair with an omental patch, if expertise is available. Read more at www.ncbi.nlm.nih.gov

Small Bowel Obstruction After Antecolic Antegastric Laparoscopic Roux-en-Y Gastric Bypass Without Division of Small Bowel Mesentery: A Single-Centre, 7-Year Review.

Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%. It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive patients undergoing primary AA-LRYGB from January 2003 to December 2009 in a single institution were retrospectively reviewed to determine the incidence, etiology, clinical symptoms, radiologic diagnostic accuracy and operative outcomes of SBO. Of the 652 patients, 63 (9.6%) developed SBO. The majority (6.9%, 45 patients) had a SBO due to IH. In 41 (91%) cases, the IH was at the jejunojejunostomy (JJ), four cases had an IH at Petersen’s space. Adhesions and ventral hernia were found in 14 (2.1%) and four (0.6%) cases, respectively. Twenty-nine out of 63 cases had negative computed tomography (CT) findings and IH was diagnosed on CT in only 33% (14/45) of patients with IH. All patients underwent diagnostic laparoscopy. No bowel resections had to be performed. In contrast to previous reports, a high incidence of SBO with a high rate of IH at the JJ site was found in our series. Accuracy of CT is low and diagnostic laparoscopy is mandatory when SBO is suspected. Since 2010 we have started closing the JJ site, and data on SBO are collected prospectively. We believe that closing of the mesenteric defects is a mandatory step, even in an AA-LRYGB. Read more at www.ncbi.nlm.nih.gov

QJM. 2011 Feb;104(2):133-9. Epub 2010 Sep 24. Prevalence and independent factors for gastroduodenal ulcers/erosions in asymptomatic patients taking low-dose aspirin and gastroprotective agents: the OITA-GF study. Tamura A, Murakami K, Kadota J; OITA-GF Study Investigators. Collaborators (24) Goto Y, Kawano Y, Naono S, Sato T, Kotoku M, Abe T, Watada M, Anan J, Tanahashi J, Mizukami K, Yasaka S, Okimoto T, Kodama M, Miyamoto K, Watanabe T, Hino M, Shinozaki K, Zaizen H, Hisamatsu A, Soma W, Nakagawa Y, Nakashima H, Okawara H, Nagai T. Source Internal Medicine 2, Oita University, Idaigaoka 1-1, Hasama-machi, Yufu 879-5593, Japan. akira@oita-u.ac.jp Abstract BACKGROUND: Although it is well known that aspirin causes gastroduodenal mucosal injury and that aspirin-induced gastroduodenal mucosal injury is often asymptomatic, the prevalence and independent factors for gastroduodenal mucosal injury have not been clarified in asymptomatic patients taking low-dose aspirin and gastroprotective agents. AIM: To clarify the prevalence and independent factors for gastroduodenal ulcers/erosions in asymptomatic patients taking low-dose aspirin and gastroprotective agents. DESIGN: Prospective observational study. METHODS: We performed endoscopy in 150 asymptomatic patients taking low-dose aspirin and gastroprotective agents for at least 3 months. RESULTS: Gastroduodenal ulcers/erosions were observed in 37.3% [ulcers (4.0%); erosions (34.0%)]. Univariate logistic regression analyses showed that proton-pump inhibitor (PPI) use was negatively associated with gastroduodenal ulcers/erosions [odds ratio (OR) 0.35, 95% confidence interval (95% CI) 0.17-0.75, P=0.007]. A multivariate logistic regression analysis selected PPI use as the only independent factor for gastroduodenal ulcers/erosions (OR 0.35, 95% CI 0.14-0.86, P=0.02). None of the 53 patients with PPI use had any gastroduodenal ulcers, and 11 with standard-dose PPI use tended to have a lower prevalence of gastroduodenal erosions than 42 with low-dose PPI use (0% vs. 28.6%, P=0.052). CONCLUSION: Gastroduodenal ulcers/erosions were observed in about one-third of asymptomatic patients taking low-dose aspirin and gastroprotective agents, and PPI use was a negative independent factor for gastroduodenal ulcers/erosions in those patients. In addition, standard-dose PPI therapy might be more effective in the prevention of aspirin-induced gastroduodenal mucosal injury than low-dose PPI therapy. Read more at www.ncbi.nlm.nih.gov

Moderately Intense Exercise Improves Fitness in Most Bariatric Surgery Patients CME

News Author: Laurie Barclay, MD CME Author: Charles P. Vega, MD

Clinical Context

Bariatric surgery has been demonstrated to substantially reduce weight among obese adults, and it can cure chronic illnesses such as type 2 diabetes mellitus and hypertension. However, the long-term outcomes of bariatric surgery may not reflect the fantastic improvements documented in the short term. A study by Sjöström and colleagues, which was published in the December 23, 2004, issue of The New England Journal of Medicine, examined patients 10 years after bariatric surgery. They found that although surgery promoted excellent weight loss from 0 to 2 years postoperatively, postsurgical patients gained a higher percentage of body weight between 2 and 10 years after surgery vs obese control patients. However, recovery rates from diabetes, hypertension, and hypertriglyceridemia remained superior in the surgery group vs the control group at 10 years.

Institution of exercise programs after bariatric surgery may help promote more sustained weight loss. The current randomized trial by Garg and colleagues examines outcomes of a postsurgical exercise training program.

Study Synopsis and Perspective

Rigorous exercise may be feasible and beneficial to maintain weight after bariatric surgery, according to the results of a randomized controlled trial reported online July 7 in Obesity.

“[W]e didn’t know until now whether morbidly obese bariatric surgery patients could physically meet this goal,” said senior author Abhimanyu Garg, chief of nutrition and metabolic diseases at University of Texas Southwestern Medical Center at Dallas, in a news release. “Our study shows that most bariatric surgery patients can perform large amounts of exercise and improve their physical fitness levels. By the end of the 12 weeks, more than half the study participants were able to burn an additional 2,000 calories a week through exercise and 82 percent surpassed the 1,500-calorie mark.”

The investigators studied the tolerability and efficacy of high-volume exercise program (HVEP) in 33 obese, postbariatric-surgery patients who had undergone Roux-en-Y gastric bypass and gastric banding. Mean body mass index (BMI) was 41 ± 6 kg/m2. Participants were assigned for 12 weeks to an HVEP (n = 21) or to a control group (n = 12). All participants were advised to limit energy intake, and the HVEP group was also counseled to take part in moderate-intensity exercise resulting in energy expenditure of at least 2000 kcal/week. Repeated measures analysis allowed determination of treatment effect.

In the HVEP group, more than half (53%) of participants expended at least 2000 kcal/week during the last 4 weeks of the study, and 82% expended at least 1500 kcal/week. Compared with the control group, the HVEP group had significant improvement at 12 weeks in step count, reported time spent and energy expended during moderate physical activity, maximal oxygen consumption relative to weight, and incremental area under the postprandial blood glucose curve (group-by-week effect: P = .009 - .03).

“We found that participants in the exercise group increased their daily step count from about 4,500 to nearly 10,000 so we know that they weren’t reducing their physical activity levels at other times of the day,” Dr. Garg said. “We also found that while all participants lost an average of 10 pounds, those in the exercise group became more aerobically fit.”

Some quality-of-life scales improved significantly in both groups. The groups did not differ significantly in changes in weight, energy and macronutrient intake, resting energy expenditure, fasting lipids and glucose, and fasting and postprandial insulin concentrations.

“HVEP is feasible in about 50% of the patients and enhances physical fitness and reduces postprandial blood glucose in bariatric surgery patients,” the study authors write.

Limitations of this study include short duration, small sample size, dropout rate higher in the control group vs the HVEP group, dietary and exercise counseling provided at an individual level and not at the group level, and use of an unsealed pedometer to measure physical activity.

“Whether a HVEP helps to maintain weight loss and improvement in comorbidities in these patients remains to be evaluated in long-term studies,” the study authors conclude. “The studies also need to assess how exercise over the long term affects factors that influence energy balance including energy intake, nonexercise activity levels, body composition, metabolic rate, and gastrointestinal hormones related to satiety and hunger.”

The National Institutes of Health and the Southwestern Medical Foundation supported this study. The study authors have disclosed no relevant financial relationships.

Obesity. Published online July 7, 2011.

Study Highlights

All study patients had received either Roux-en-Y bypass or gastric banding surgery within 3 months of study enrollment, and all had a baseline BMI of 35.5 kg/m2 or more. Study participants were between the ages of 18 and 65 years, and they exercised less than 20 minutes per day during the previous 3 months.

Participants were randomly assigned to an exercise group or to a control group. The goal for the exercise group was to expend at least 2000 kcal/week in moderate-intensity aerobic exercise at 60% to 70% of maximal oxygen consumption. Exercise was increased gradually to achieve this goal, and participants were asked to exercise at least 5 times per week. Exercise was partially supervised during 1 to 2 sessions per week.

The control group did not receive specific exercise instructions.

Both treatment groups received similar recommendations regarding diet, with recommended calorie restrictions of 1200 to 1500 kcal/day.

Participants in the exercise group received behavioral therapy regarding exercise and diet, whereas control participants received behavioral therapy regarding diet alone.

The study interventions lasted 12 weeks.

The main study outcome was physical fitness, as measured by maximal oxygen consumption on exercise testing. Researchers also measured total physical activity levels and resting energy expenditure, and they followed body weight as well as body composition using dual-energy x-ray absorptiometry. Finally, researchers measured multiple metabolic variables and participants’ quality of life.

21 patients were randomly assigned to the exercise group, and 12 patients comprised the control group. The mean age of participants was approximately 50 years, and the mean BMI was 41 kg/m2. More than 90% of participants were women.

4 participants dropped out of the control group, as did 5 participants in the exercise group.

During the last 4-week period of the study intervention, 53% of participants in the exercise group expended at least 2000 kcal/week, and 82% expended at least 1500 kcal/week. The mean number of steps daily in the exercise group increased from 5500 at baseline to nearly 10,000 at 12 weeks.

The time spent in exercise increased 3 times vs baseline levels in the exercise group but remained stable in the control group.

The maximal oxygen consumption during exercise (adjusted for body weight) increased by 10% in the exercise group but decreased very slightly in the control group.

Resting energy expenditure was similar in the exercise and control groups.

Participants in the exercise group experienced a more significant increase in total caloric intake between weeks 6 and 12 of the study.

Body weight, waist circumference, and hip circumference declined to similar degrees in the exercise and control groups, and there was a small and similar decline in percent total body fat in both groups.

The 2 treatment groups were also similar in fasting as well as in postprandial serum insulin and glucose levels. However, the mean incremental area under the curve postprandial glucose response was lower in the exercise group vs the control group.

Serum lipid and blood pressure values were also similar in comparing the exercise group vs the placebo group.

Quality of life improved at 12 weeks in the 2 treatment groups to a similar degree.

Clinical Implications

A previous study suggested that early weight loss after bariatric surgery might not be effectively sustained at 10 years. However, recovery rates from diabetes, hypertension, and hypertriglyceridemia remained superior in the surgery group vs the control group at 10 years.

The current study demonstrates that a 12-week exercise program after bariatric surgery failed to improve most research outcomes, but physical fitness was superior in the exercise group vs the control group. Read more at www.medscape.org

Obes Surg. 2011 Jul 1. [Epub ahead of print]

ESR1, FTO, and UCP2 Genes Interact with Bariatric Surgery Affecting Weight Loss and Glycemic Control in Severely Obese Patients.

Liou TH, Chen HH, Wang W, Wu SF, Lee YC, Yang WS, Lee WJ.

Source Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

Abstract BACKGROUND: Significant variability in weight loss and glycemic control has been observed in obese patients receiving bariatric surgery. Genetic factors may play a role in the different outcomes. METHODS: Five hundred and twenty severely obese patients with body mass index (BMI) ≥35 were recruited. Among them, 149 and 371 subjects received laparoscopic adjustable gastric banding (LAGB) and laparoscopic mini-gastric bypass (LMGB), respectively. All individuals were genotyped for five obesity-related single nucleotide polymorphisms on ESR1, FTO, PPARγ, and UCP2 genes to explore how these genes affect weight loss and glycemic control after bariatric surgery at the 6th month. RESULTS: Obese patients with risk genotypes on rs660339-UCP2 had greater decrease in BMI after LAGB compared to patients with non-risk genotypes (-7.5 vs. -6 U, p = 0.02). In contrast, after LMGB, obese patients with risk genotypes on either rs712221-ESR1 or rs9939609-FTO had significant decreases in BMI (risk vs. non-risk genotype, -12.5 vs. -10.0 U on rs712221, p = 0.02 and -12.1 vs. -10.6 U on rs9939609, p = 0.04) and a significant amelioration in HbA1c levels (p = 0.038 for rs712221 and p < 0.0001 for rs9939609). The synergic effect of ESR1 and FTO genes on HbA1c amelioration was greater (-1.54%, p for trend <0.001) than any of these genes alone in obese patients receiving LMGB. CONCLUSIONS: The genetic variants in the ESR, FTO, and UCP2 genes may be considered as a screening tool prior to bariatric surgery to help clinicians predict weight loss or glycemic control outcomes for severely obese patients. Read more at www.ncbi.nlm.nih.gov