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Background: Currently, there is conflicting evidence linking Helicobacter pylori (HP) infection with weight loss and endoscopic findings after Roux-en-Y gastric bypass (RYGB). Objective: To identify correlations between HP infection and its eradication with weight loss and endoscopic findings after RYGB. Methods: This is an observational retrospective cohort study based on a prospectively collected database of individuals who underwent RYGB from 2018-2019 at a tertiary university hospital. HP infection and the HP eradication therapy outcomes were correlated with post-operative weight loss and endoscopic findings. Individuals were classified according to the status of HP infection into four groups: no infection; successful eradication; refractory infection; and new-onset infection. Results: Of 65 individuals, 87% were female and the mean age was 39±11.2 years. Body mass index significantly decreased from 36.2±3.6 to 26.7±3.3 kg/m2 one year after RYGB (P

To analyze relationships of hepatic histopathological findings and bile microbiological profiles with perioperative outcomes and risk of late biliary stricture in individuals undergoing surgical bile duct injury (BDI) repair.A historical cohort study was carried out at a tertiary university hospital. Fifty-six individuals who underwent surgical BDI repair from 2014-2018 with a minimal follow-up of 24 months were enrolled. Liver biopsies were performed to analyze histopathology. Bile samples were collected during repair procedures. Hepatic histopathological findings and bile microbiological profiles were then correlated with perioperative and late outcomes through uni- and multi-variate analyses.Forty-three individuals (76.8%) were females and average age was 47.2 ± 13.2 years; mean follow-up was 38.1 ± 18.6 months. The commonest histopathological finding was hepatic fibrosis (87.5%). Bile cultures were positive in 53.5%. The main surgical technique was Roux-en-Y hepaticojejunostomy (96.4%). Overall morbidity was 35.7%. In univariate analysis, liver fibrosis correlated with the duration of the operation (R = 0.3;Bacterial contamination of bile was observed in most cases. The degree of fibrosis and cholestasis correlated with operative time. The waiting time for definitive repair correlated with the severity of liver fibrosis.

Excess bodily iron content is commonly associated with obesity and metabolic associated medical conditions and is thought to lead to cardiovascular disease. The effect of Roux-en-Y gastric bypass (RYGB) on hepatic iron overload remains to be determined.To assess the evolution of histologically proven hepatic iron overload after RYGB.This is an exploratory historical cohort study in which 42 individuals who underwent RYGB, and then a second surgical procedure had paired liver biopsies collected. Hepatic iron overload and NAFLD features were assessed through histopathological examination. Biochemical iron metabolism parameters were also assessed.The mean age at RYGB was 47 ± 10.2 years and 92.9% were female. The average time elapsed between RYGB and the second surgical procedure was 20.6 ± 15.4 months. The mean percentage of total weight loss between the two procedures was 26.7 ± 9.4%. Significant reductions in ferritin (220.8 ± 202.9 vs. 101.6 ± 116.7 ng/mL; p = 0.006), hemoglobin (13.7 ± 1.8 vs. 12.1 ± 2.6 g/dL; p = 0.01), and red blood cell count (4.7 ± 0.7 vs. 4.3 ± 0.5 10RYGB led to a significant decrease in hepatic iron overload, emerging as a possible therapeutical tool for this condition in individuals with obesity and dysmetabolic iron overload syndrome.

Background: Helicobacter pylori infection has been reported to lead to post-operative complications after bariatric surgery (BS), especially marginal ulcers. The optimal method for pre-operative screening is yet to be determined. Objective: To analyze the diagnostic accuracy of the endoscopic urease test for the detection of H. pylori in individuals undergoing BS and the main endoscopic and histological changes within this population. Methods: A cross-sectional study was carried out based on a database from medical records of 232 individuals who underwent BS between 2016 and 2019 at a tertiary university hospital. Clinical, anthropometric, and endoscopic data were analyzed. The gold-standard method considered to calculate diagnostic accuracy variables was histopathological examination through hematoxylin-eosin/Giemsa stains. Results: 87.5% of the participants were female; mean age was 38.5±9.5 years and average body mass index was 37.6±3.8 kg/m2. The commonest endoscopic finding was gastritis (50.9%) with a predominance of the mild erosive form (25%). Upon histological examination, 59.1% of the participants had confirmed H. pylori infection. H. pylori infection was associated with higher frequencies of endoscopic duodenitis (23.4% vs 12.6%; P=0.04), histological chronic gastritis (100% vs 56.8%; P

Slight to moderate hepatic iron overload (HIO) can be found in cases of liver disease, including non-alcoholic fatty liver disease (NAFLD), but the mechanism is not completely understood, as well as its relationship with obesity. To determine the prevalence of HIO assessed through histopathological examination in obese individuals undergoing bariatric surgery and to identify correlations between this condition and demographic, anthropometric, clinical, laboratory, and NAFLD-related aspects. This is a cross-sectional study which enrolled individuals undergoing bariatric surgery from January 2018 to February 2019 at a tertiary university hospital. NAFLD and HIO were assessed through histological examination. Of 125 individuals, 87.2% were female and the average age was 38.8 ± 9.2 years. The average BMI was 37.2 ± 3.1 kg/m2. NAFLD was present in 66.4% and HIO in 17.6%, with 63.6% of patients with overload classified as mild (grade I) and 22.7% moderate (grade II). HIO was significantly more frequent in males (p = 0.003) and was significantly associated with higher levels of glucose (92.1 ± 28.4 vs. 80.7 ± 39.6; p = 0.02), ferritin (385.5 ± 290.9 vs. 131.6 ± 99.7; p

Obesity affects approximately 45–55% of persons with schizophrenia and is more difficult to manage in these individuals than in the general population, apart from being an additional factor for morbidity and premature mortality. Although bariatric surgery is considered the most effective long-term treatment for severe obesity, there are few reports on the outcomes of this procedure in persons with schizophrenia. This study aimed to evaluate weight loss and psychiatric symptoms in persons with obesity and schizophrenia after bariatric surgery. Five persons with schizophrenia and moderate to severe obesity who underwent bariatric surgery were followed up for 2 years. Anthropometric data were collected, and psychiatric symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), which assessed the pre- and postoperative occurrence and severity of symptoms of schizophrenia. The mean body mass index before surgery was 43.5 ± 5.2 kg/m2 and decreased to 28.1 ± 1.9 kg/m2 1 year postoperatively. The mean percentage of total postoperative weight loss was 30.7 ± 6.8% after 6 months, 34.7 ± 7.9% after 1 year, and 34.3 ± 5.5% after 2 years. Before surgery, all subjects were in remission based on the PANSS. Postoperative evaluations showed that the participants had no relapse of psychiatric symptoms (p > 0.05 for the three PANSS dimensions throughout the follow-up period). There were no considerable changes in their medication regimens. These findings suggest that bariatric surgery may be a viable treatment option for stable patients with schizophrenia if they have a preoperative assessment and close management and involvement by mental health professionals throughout the course of treatment.

We hypothesize that non-alcoholic fatty liver disease (NAFLD) may be significantly associated with waist circumference (WC), neck circumference (NC), hip circumference (HC), and waist-to-hip ratio (WHR). To analyze correlations between anthropometric parameters and the occurrence and intensity of NAFLD aspects assessed by histopathological examination in individuals undergoing bariatric surgery. This is a cross-sectional study carried out in a tertiary university hospital. Demographic, clinical, anthropometric, laboratory, and histopathological variables were analyzed; uni- and multivariate analyses were performed. Histopathological variables analyzed were findings of liver biopsies collected during surgical procedures. Of 119 individuals, 105 (88.2%) were female. The mean age was 38.8 ± 9.3 years and the mean BMI was 37.6 ± 3.1 kg/m2. The prevalence of NAFLD histopathological aspects was: steatosis (76.5%), steatohepatitis (49.6%), and fibrosis (51.3%). WC was significantly higher in individuals with steatosis (103.5 ± 9.9 vs. 99.4 ± 8.4; p = 0.03). Individuals with steatohepatitis presented significantly higher BMI (38.2 ± 3.2 vs. 36.7 ± 2.8; p = 0.01), WC (105.3 ± 10.4 vs. 99.6 ± 8.8; p = 0.002), and WHR (1 ± 0.1 vs. 0.9 ± 0.1; p = 0.02). Age (40.6 ± 9.7 vs. 37 ± 8.5; p = 0.03) and hemoglobin A1c (6.5 ± 0.5 vs. 5.6 ± 0.5; p = 0.004) were significantly higher among individuals with fibrosis. A positive correlation was observed between the steatosis intensity and WHR (R = 0.2; p = 0.04). BMI (R = 0.2; p = 0.02) and glucose (R = 0.2; p = 0.009) were independently correlated with the steatohepatitis intensity. Age (R = 0.3; p = 0.04) was independently correlated with the fibrosis intensity. There were significant associations between anthropometric parameters and NAFLD aspects. WC and WHR were associated with steatosis; BMI, WC, and WHR were associated with steatohepatitis. WHR independently correlated with steatosis intensity.

The technology of extracorporeal shock wave therapy (ESWT) has been studied around the world for its possible benefits in the treatment and rehabilitation of aesthetic disorders. To better elucidate its real physiological effect on the integumentary tissue, this study was proposed aimed at evaluating whether ESWT can act to stimulate the inflammatory process and angiogenesis in the dermis and epidermis of obese individuals. This is an immunohistological study that evaluated a set of samples of the integumentary tissue of women with grade II obesity with weight loss of 10% of the initial weight undergoing ESWT treatment; the collection of biological material was performed at the time of surgery of bariatric surgery. For immunohistochemical evaluation, the markers to assess the presence and distribution of inflammatory cells, anti-COX-2, CD3, CD20, CD163, and NK were used. For physiological stimulus pathways for blood vessel angiogenesis, markers CD 34, CD 105 and VEGF were used. Fourteen obese women were included in the study. Positivity was evidenced in the epidermal expression of markers of the inflammatory process COX-2, CD3, CD20, NK cells, CD68, and CD163 (p

Introduction: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. Objective: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. Methods: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. Results: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. Conclusion: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed. RESUMO Introdução: atualmente, a cirurgia bariátrica é o único tratamento que leva à perda de peso prolongada e sustentada e diminuição da morbimortalidade em indivíduos obesos mórbidos. O bypass em Y-de-Roux causa perda de peso restringindo a ingestão de alimentos associada à redução da absorção intestinal, além de múltiplos efeitos endócrinos e sacietógenos. O desvio biliopancreático promove a perda de peso principalmente devido à diminuição da absorção dos nutrientes ingeridos. Ambos os procedimentos excluem partes do trato gastrointestinal. Objetivo: descrever 4 casos de cirurgia revisional após cirurgia bariátrica primária, devido a graves complicações nutricionais, bem como realizar uma revisão da literatura sobre esse assunto. Métodos: foi realizada uma análise retrospectiva dos pacientes do banco de dados do serviço de cirurgia bariátrica da Unicamp e revisão da literatura. Resultados: foram identificados 4 pacientes, 2 mulheres e 2 homens, com média de idade de 48 anos, o IMC antes da cirurgia revisional eram em média 23,7. Os pacientes haviam sido submetidos em 3 casos a cirurgia de Scopinaro e 1 caso ao bypass gástrico em Y-de-Roux. As cirurgias revisionais foram de revisão, conversão e reversão. Um paciente evoluiu a óbito. Em relação a revisão da literatura, foram selecionados 12 artigos (11 relatos de casos e 1 série de casos). Outros cinco artigos originais importantes foram incluídos. Conclusão: felizmente, a cirurgia revisional raramente é necessária, mas, quando indicada, apresenta alta morbidade. São cirurgias de revisão, reversão ou conversão, de acordo com a gravidade do paciente e a cirurgia primária realizada.

The influence of post-surgical weight regain on the course of non-alcoholic fatty liver disease (NAFLD) is unclear. To evaluate the influence of weight regain on the NAFLD assessed by means of a non-invasive score after Roux-en-gastric bypass (RYGB) over a 3-year period. This is a prospective observational cohort study which evaluated individuals who underwent RYGB. Comparisons were made between the periods immediately before surgery and 12, 24, and 36 months following surgery. Liver disease was estimated by means of the NAFLD fibrosis score. Individuals were classified into three categories according to weight regain status: (1) no weight regain, (2) expected weight regain (regain less or equal than 20% of the maximal weight lost), (3) obesity recidivism (regain above 20% of the maximal weight lost). Of 90 patients analyzed after 3 years of surgery, 35.6% presented obesity recidivism and 28.8% of the expected regain; 35.6% presented no regain. There was no difference in baseline fibrosis score between groups; at 3 years, the score observed in the relapse group was significantly higher than that observed in the other two groups (p = 0.015). The percent variation of the fibrosis score was significantly higher in the recidivism group (+ 11.8 ± 77.2%) than in the expected regain (− 45.6 ± 64.5%) and no regain (− 37.8 ± 63.2%) groups (p = 0.013). Long-term significant post-RYGB weight regain is associated with a significantly attenuated improvement of NAFLD evaluated by means of liver fibrosis score.

Summary Introduction: Due to population ageing, the elderly obese population is increasing. Bariatric surgery is the standard treatment option for morbid obesity nowadays, but there is some controversy regarding its routine indication in the elderly population. Objetive: To review the current evidence about bariatric surgery in the elderly. Method: On-line search in the electronic databases Medline and Lilacs and compilation of the most significant data. The most relevant studies in the area over the past 16 years have been considered for this review. Results: There was significant methodological heterogeneity in the studies found in the literature. Historically, old age was associated with poorer outcomes after bariatric surgery, both in regards to early postoperative complications and less weight loss, and resolution of comorbidities. More recent studies have shown better results, with morbidity and mortality comparable to those observed in younger populations. More cautious patient selection and the evolution of the surgical technique appear to be the cause of such improvement. An extended multidisciplinary team including a geriatrician and a social worker may also help to improve the preoperative approach. Conclusion: Bariatric surgery is a safe and effective therapeutic option in the elderly population, but careful patient selection and specific preoperative assessment are mandatory. Resumo Introdução: Em virtude do envelhecimento populacional, a população obesa idosa também está aumentando. A cirurgia bariátrica é o tratamento padrão-ouro para obesidade mórbida atualmente, porém sua realização rotineira em idosos ainda é controversa. Objetivo: Revisar a literatura atual sobre a cirurgia bariátrica em idosos. Método: Revisão on-line das bases de dados eletrônicas Medline e Lilacs e compilação dos dados mais significativos. Os estudos mais relevantes na área nos últimos 16 anos foram considerados para esta revisão. Resultados: Houve grande heterogeneidade metodológica nos estudos encontrados. Historicamente, a idade avançada estava associada a resultados inferiores após a cirurgia bariátrica, em relação tanto a complicações pós-operatórias quanto à perda de peso e resolução de comorbidades. Estudos mais recentes têm mostrado resultados melhores, com morbidade e mortalidade comparáveis às observadas em indivíduos mais jovens. A seleção criteriosa de pacientes e a evolução da técnica cirúrgica parecem estar ligadas a essa melhora. Uma equipe multidisciplinar expandida, com geriatra e assistente social, pode também colaborar para uma melhor abordagem pré-operatória. Conclusão: A cirurgia bariátrica é uma opção terapêutica segura e efetiva na população idosa, mas uma seleção criteriosa de pacientes e avaliação pré-operatória específica precisam ser realizadas.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the commonest hepatopathy worldwide. OBJECTIVE: To investigate the correlations between NAFLD histopathological features and the levels of adipokines (adiponectin, leptin, and resistin) and circulating inflammatory markers (interleukin-6 [IL-6], interleukin-8 [IL-8], tumor necrosis factor alpha [TNF-α], and C-reactive protein [CRP]). METHODS: This is an exploratory cross-sectional study, which enrolled 19 women with obesity who underwent bariatric surgery. Biochemical characteristics evaluated included the levels of adiponectin, leptin, resistin, IL-6, IL-8, TNF-α, and CRP. NAFLD was assessed through histological examination of liver biopsies carried out during the surgical procedures. RESULTS: The mean age of the study group was 37.3±8.2 years old; mean BMI was 36.2±2.5 kg/m2. Among individuals with liver fibrosis, the levels of IL-8 were significantly higher (24.4 ± 9.7 versus 12.7 ± 6.6; P=0.016726). The intensity of fibrosis presented a significant negative correlation with the levels of adiponectin (R= -0.49379; P=0.03166); i.e. the higher the levels of adiponectin, the lower the intensity of fibrosis. The intensity of steatohepatitis presented a significant negative correlation with the levels of adiponectin (R= -0.562321; P=0.01221); this means that the higher the levels of adiponectin, the lower the intensity of steatohepatitis. CONCLUSION: Adiponectin levels were inversely correlated with the severity of fibrosis and steatohepatitis, whereas IL-8 levels were higher in individuals with liver fibrosis among individuals with obesity and NAFLD undergoing bariatric surgery. The use of these markers to assess NAFLD may bring significant information within similar populations.

BACKGROUND: Although the incidence of leaks after Roux-en-Y gastric bypass (RYGB) significantly decreased over time, their detection still remains challenging. OBJECTIVE: This study aimed to determine the usefulness of drain amylase levels to detect leaks after RYGB. METHODS: This is a population-based study which enrolled 170 individuals who underwent RYGB. Drain amylase levels were determined on the first and fourth postoperative days. Two thresholds were evaluated: three times higher than the serum levels (parameter I) and higher than 250 IU/L (parameter II). The main outcomes evaluated were perioperative morbidity, the occurrence of leaks, 30-day readmissions and reoperations, hospital stay, and mortality. RESULTS: Considering the parameter I, high drain amylase levels were significantly associated with leaks (12.5% vs 0; P

Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher. Resumo Introdução: A cirurgia bariátrica tornou-se nos últimos anos o tratamento padrão-ouro para a obesidade mórbida; porém, entre obesos portadores de hepatopatia crônica, não existe consenso a respeito de sua segurança e efetividade. Objetivo: Análise crítica da literatura existente sobre a realização de cirurgia bariátrica em portadores de cirrose hepática. Método: Revisão narrativa por meio de pesquisa online nas bases de dados Medline e Lilacs. Resultados: As cirurgias bariátricas em indivíduos cirróticos sem descompensação clínica levam a resultados satisfatórios. Já indivíduos com hepatopatia grave apresentam morbidade perioperatória e mortalidade significativamente maiores do que as observadas na população obesa sem hepatopatia. Em candidatos a transplante hepático, a cirurgia pode ser realizada antes, durante ou após o transplante, havendo uma tendência predominante à realização após o transplante. A gastrectomia vertical parece ser a técnica mais adequada nesse grupo de pacientes. Conclusão: A cirurgia bariátrica é segura e efetiva em portadores de cirrose hepática compensada e sem hipertensão portal; porém, apresenta maior morbidade. Em candidatos a transplante e/ou indivíduos com hipertensão portal significativa, a morbimortalidade é significativamente maior.

Obesity is a disease characterized by excess fat in the body that results in damage to health. Several cardiovascular diseases, diabetes, musculoskeletal disorders and some neoplasms are considered to be comorbidities related to obesity, as well as urinary dysfunction and, as a result, a deficit in quality of life. Adherence to physical activity can be part of the adoption of healthier lifestyles and assist in the treatment of obesity and comorbidities related to it, as well as urinary dysfunction and quality of life. Thus, the aim of the present study was to evaluate the influence of physical activity on the quality of life of morbidly obese individuals who have urinary dysfunction. This is a cross-sectional observational pilot study. The anthropometric variables collected were weight; height; Body Mass Index (BMI); and average waist circumference. The level of physical activity of the patients was assessed using IPAQ SF –International Physical Activity Questionnaire Short Form. To characterize the patients in relation to the percentage of fat, the Prediction Equation for Obese Individuals – Women was used. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). Quality of life was assessed using the questionnaire WHOQOL BREF –World Health Organization Quality of Life Assessment Bref. A total of 47 individuals were approached and evaluated, being 31 active and 16 sedentary. There was no significant correlation between the variables analyzed in the group of active individuals. However, in the group of sedentary individuals, significant negative correlations were found between BMI and quality of life general (R=-0.610; p=0.011), physical domain (R=-0.642; p=0.007) and psychological domain (R=-0.625; p=0.009); and between percentage of fat and quality of life general (R=-0.609; p=0.012), physical domain (R=-0.637; p=0.007) and psychological domain (R=-0.590; p=0.015). Among sedentary obese people with urinary dysfunction, a significant impairment of quality of life was registered, especially in the general scope and in the physical and psychological domains. In the group of active obese patients with urinary dysfunction, there was no significant correlation between the variables analyzed.

PURPOSE: To measure the content of acidic mucin, sialomucin, and sulfomucins in the colonic mucosa without fecal stream submit to intervention with sucralfate (SCF).METHODS: Thirty-six rats were submitted to a right colostomy and a distal mucous fistula and divided into two groups according to sacrifice to be performed two or four weeks. Each group was divided into three subgroups according daily application of enemas containing saline, SCF at 1.0 g/kg/day or 2.0 g/kg/day. Colitis was diagnosed by histological analysis. Acid mucins were determined with the Alcian-Blue and sulfomucin and sialomucin by high iron diamine-alcian blue (HID-AB) techniques. The mucins were quantified by computer-assisted image analysis. Mann-Whitney and ANOVA tests were used to analyze the results establishing the level of significance of 5% for both (p

PURPOSE:To evaluate the effects of sucralfate on tissue content of neutral and acids mucins in rats with diversion colitis.METHODS: Thirty-six rats were submitted to a proximal right colostomy and a distal mucous fistula. They were divided into two groups according to sacrifice to be performed two or four weeks after intervention. Each group was divided into three subgroups according daily application of enemas containing saline, sucralfate at 1.0 g/kg/day or 2.0 g/kg/day. Colitis was diagnosed by histological analysis and neutral and acid mucins by Periodic Acid Schiff and Alcian Blue techniques, respectively. The contents of mucins were quantified by computer-assisted image analysis. Student's t paired and ANOVA test were used to compare the contents of both types of mucins among groups, and to verify the variance with time, establishing level of signification of 5% for both (p