Correlação da infecção por helicobacter pylori entre pacientes submetidos a vagotomia gastrica proximal ha mais de dez anos, pacientes com sindrome dispeptico e com ulcera peptica duodenal

Orientador: Osvaldo MalafaiaDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: A vagotomia gástrica proximal foi considerada, durante os anos 70 e 80, como uma das melhores opções para o tratamento cirúrgico da úlcera péptica duodenal. Com o advento dos bloqueadores H2 e, mais tarde, com os da bomba de próton esta operação foi relegada a segundo plano. A intratabilidade clínica tornou-se uma indicação de exceção. Em 1983 o Helicobacter pylori ío\ divulgado na literatura médica. Havia sido descrito no passado como uma bactéria de menor importância, nunca associada a doença ulcerosa péptica, gastrite ou outra afecção gástrica. Atualmente passou a ter um importante papel na etiologia da gastrite, da ulceração péptica e outras doenças. O presente estudo compara três grupos de pacientes: o primeiro consistiu em pacientes com história pregressa de vagotomia gástrica proximal realizada há mais de dez anos para úlcera duodenal, com uma incidência de recidiva de 27%, o segundo grupo foi formado por pacientes com úlcera duodenal ativa e finalmente o terceiro por pacientes examinados devido ao seu síndrome dispéptico. O teste da urease para o Helicobacter pylori io \ realizado em todos os pacientes e mostrou os mesmos resultados encontrados na literatura corrente. Pacientes submetidos a vagotomia gástrica proximal tiveram um índice similar de infecção gástrica por tal bactéria quando comparados com os pacientes portadores de úlcera duodenal ativa. Foi observada semelhança estatisticamente significante entre estes dois grupos. Os pacientes portadores de síndrome dispéptico tiveram a mesma incidência pelo Helicobacter pylori que a descrita na literatura médica. A vagotomia gástrica proximal modificou a história natural da úlcera péptica duodenal a despeito da presença do Helicobacter pylori.Abstract: Proximal gastric vagotomy was considered, during the years seventies and eighties, as one of the best choices for the surgical treatment of duodenal peptic ulcer disease. With the advent of the H2 blockers and, later on, the protonic bomb blockers this operation was left aside. Clinical intractability became an exceptional indication. In 1983 Helicobacter pylori came to the knowledge of medical literature. It had been described as meaningless gastric bacteria but never associated to peptic ulcer disease, gastritis or other gastric abnormal situation. Now a days it is considered to play in important role in the ethiology of gastritis, peptic ulceration and others diseases. The present study compared three groups of patients: the first one was a group with a past history of proximal gastric vagotomy done, ten or more years earlier, for duodenal ulcer disease, with 27% recurrence rate, the second group consisted of patients with active duodenal ulcers and finally the third one was examined because their dyspeptic syndrome. The urease test for Helicobacter pyloriwas performed in all patients and showed the same results as currently published. Patients submitted to proximal gastric vagotomy had a similar index of gastric infection by such bacteria when compared with those patients with active peptic duodenal ulcer disease. Statistic significance was observed in such similarity. The dyspeptic syndrome group of patients had the same incidence of Helicobacter pylori infection as described in the medical literature. Proximal gastric vagotomy modified the natural history of peptic ulcer disease inspite of the presence of Helicobacter pylori

Correlação da infecção por helicobacter pylori entre pacientes submetidos a vagotomia gastrica proximal ha mais de dez anos, pacientes com sindrome dispeptico e com ulcera peptica duodenal

Orientador: Osvaldo MalafaiaDissertação (mestrado) - Universidade Federal do Parana, Setor de Ciencias da SaudeResumo: A vagotomia gástrica proximal foi considerada, durante os anos 70 e 80, como uma das melhores opções para o tratamento cirúrgico da úlcera péptica duodenal. Com o advento dos bloqueadores H2 e, mais tarde, com os da bomba de próton esta operação foi relegada a segundo plano. A intratabilidade clínica tornou-se uma indicação de exceção. Em 1983 o Helicobacter pylori ío\ divulgado na literatura médica. Havia sido descrito no passado como uma bactéria de menor importância, nunca associada a doença ulcerosa péptica, gastrite ou outra afecção gástrica. Atualmente passou a ter um importante papel na etiologia da gastrite, da ulceração péptica e outras doenças. O presente estudo compara três grupos de pacientes: o primeiro consistiu em pacientes com história pregressa de vagotomia gástrica proximal realizada há mais de dez anos para úlcera duodenal, com uma incidência de recidiva de 27%, o segundo grupo foi formado por pacientes com úlcera duodenal ativa e finalmente o terceiro por pacientes examinados devido ao seu síndrome dispéptico. O teste da urease para o Helicobacter pylori io \ realizado em todos os pacientes e mostrou os mesmos resultados encontrados na literatura corrente. Pacientes submetidos a vagotomia gástrica proximal tiveram um índice similar de infecção gástrica por tal bactéria quando comparados com os pacientes portadores de úlcera duodenal ativa. Foi observada semelhança estatisticamente significante entre estes dois grupos. Os pacientes portadores de síndrome dispéptico tiveram a mesma incidência pelo Helicobacter pylori que a descrita na literatura médica. A vagotomia gástrica proximal modificou a história natural da úlcera péptica duodenal a despeito da presença do Helicobacter pylori.Abstract: Proximal gastric vagotomy was considered, during the years seventies and eighties, as one of the best choices for the surgical treatment of duodenal peptic ulcer disease. With the advent of the H2 blockers and, later on, the protonic bomb blockers this operation was left aside. Clinical intractability became an exceptional indication. In 1983 Helicobacter pylori came to the knowledge of medical literature. It had been described as meaningless gastric bacteria but never associated to peptic ulcer disease, gastritis or other gastric abnormal situation. Now a days it is considered to play in important role in the ethiology of gastritis, peptic ulceration and others diseases. The present study compared three groups of patients: the first one was a group with a past history of proximal gastric vagotomy done, ten or more years earlier, for duodenal ulcer disease, with 27% recurrence rate, the second group consisted of patients with active duodenal ulcers and finally the third one was examined because their dyspeptic syndrome. The urease test for Helicobacter pyloriwas performed in all patients and showed the same results as currently published. Patients submitted to proximal gastric vagotomy had a similar index of gastric infection by such bacteria when compared with those patients with active peptic duodenal ulcer disease. Statistic significance was observed in such similarity. The dyspeptic syndrome group of patients had the same incidence of Helicobacter pylori infection as described in the medical literature. Proximal gastric vagotomy modified the natural history of peptic ulcer disease inspite of the presence of Helicobacter pylori

Effects of bariatric surgery on the central nervous system and eating behavior in humans: a systematic review on the neuroimaging studies

INTRODUCTION: Neuroimaging studies suggest that obese people might show hyperactivity of brain areas regarding reward processing, and hypoactivity of brain areas concerning cognitive control, when exposed to food cues. Although the effects of bariatric surgery on the central nervous system and eating behavior are well known, few studies have used neuroimage techniques with the aim of investigating the central effects of bariatric surgery in humans. OBJECTIVES: This paper systematically and critically reviews studies using functional neuroimaging to investigate changes on the patterns of activation of central areas related to the regulation of eating behavior after bariatric surgery. METHOD: A search on the databases Medline, Web of Science, Lilacs and Science Direct on Line, was conducted in February 2013, using the keywords "Neuroimaging", "Positron-Emission Tomography", "Magnetic Resonance Imaging", "Gastric Bypass", "Gastroplasty", "Jejunoileal Bypass", "Bariatric Surgery". RESULTS: Seven manuscripts were included; the great majority studied the central effects of Roux en Y gastric bypass, using positron emission tomography or functional magnetic resonance. CONCLUSIONS: Bariatric surgery might normalize the activity of central areas concerned with reward and incentive salience processing, as the nucleus accumbens and mesencephalic tegmental ventral area, as well as circuitries processing behavioral inhibition, as the dorsolateral prefrontal cortex

Duodenojejunostomia em ratos não obesos - Desenvolvimento de nova técnica para tratamento cirúrgico do Diabetes.

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30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI < 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI > 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 & PLUSMN; 24.4 Kgs and 43.03 & PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = < 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients