Physiologie de l’absorption alimentaire: diversion biliopancréatique. Mise à jour à propos de 3000 interventions

A propos of a series of 3,000 procedures, 162 of which were performed laparoscopically, the author presents the advantages and drawbacks of biliopancreatic bypass (DBP). DBP allows an over 70% initial excess weight loss, both in obese and superobese patients ; the weight loss remains constant and above all it is long lasting (25 years). In fact, DBP has a favourable effect on glucose metabolism, with 98% of cases of diabetes cured at 10 years ; it lowers serum cholesterol lastingly and increases HDL cholesterol. DBP also regulates blood pressure in 80% of cases at 10 years. DBP could represent the most powerful treatment against hyperlipidemia and type II diabetes mellitus. Anaemia, bone demineralisation, gastric ulcer and peripheral neuropathy are easily controlled ; the major problem is that of protein malnutrition (MP) both in its early episodic form and recurring form. In "ad hoc DBP " the author tailors the procedure to patient characteristics, namely gastric volume and length of feeding loop. In his last 300 operated patients, his results at 10 years are 1% of recurring MP leading to 1% reoperations, with a 71% permanent loss of initial excess weight. KEYWORDS: Obesity, Biliopancreatic bypass (DBP), Metabolic syndrome, Type II diabetes, HyperlipidemiaL'auteur à propos d'une série de 3 000 interventions, dont 162 réalisées par voie coelioscopique, présente les avantages et les inconvénients de la diversion bilio-pancréatique (DBP). La DBP assure une réduction de plus de 70% de l'excès pondéral initial, tant chez les obèses que chez les superobèses ; cette perte de poids est constante et surtout se maintient à très long terme (25 ans). La DBP a un effet très favorable sur le métabolisme du glucose, avec 98% de guérison du diabète à 10 ans ; elle réduit à long terme le cholestérol sérique avec augmentation du HDL cholestérol. Elle normalise la tension artérielle dans 80% des cas à 10 ans. Elle constituerait ainsi le traitement le plus puissant de l'hyperlipidémie et du diabète sucré type II. L'anémie, la déminéralisation osseuse, l'ulcère gastrique et la neuropathie périphérique peuvent être contrôlés aisément ; le problème le plus important est celui de la malnutrition protéique (MP), qu'il s'agisse de la forme épisodique précoce ou de la forme récurrente. L'auteur, en adaptant aux caractéristiques du patient dans la "DBP ad hoc" le volume gastrique d'une part, et la longueur de l'anse alimentaire d'autre part, obtient à 10 ans chez les 300 derniers opérés, 1% de MP récurrente entraînant 1% de réinterventions, avec une réduction permanente de 71% de l'excès de poids initial. MOTS CLÉS: Obésité, Dérivation bilio-pancréatique (DBP), Syndrome métabolique, Diabète type II, Hyperlipidémi

Investigating the association between obesity and asthma in 6- to 8-year-old Saudi children:a matched case-control study

Background: Previous studies have demonstrated an association between obesity and asthma, but there remains considerable uncertainty about whether this reflects an underlying causal relationship. Aims: To investigate the association between obesity and asthma in pre-pubertal children and to investigate the roles of airway obstruction and atopy as possible causal mechanisms. Methods: We conducted an age- and sex-matched case–control study of 1,264 6- to 8-year-old schoolchildren with and without asthma recruited from 37 randomly selected schools in Madinah, Saudi Arabia. The body mass index (BMI), waist circumference and skin fold thickness of the 632 children with asthma were compared with those of the 632 control children without asthma. Associations between obesity and asthma, adjusted for other potential risk factors, were assessed separately in boys and girls using conditional logistic regression analysis. The possible mediating roles of atopy and airway obstruction were studied by investigating the impact of incorporating data on sensitisation to common aeroallergens and measurements of lung function. Results: BMI was associated with asthma in boys (odds ratio (OR)=1.14, 95% confidence interval (CI), 1.08–1.20; adjusted OR=1.11, 95% CI, 1.03–1.19) and girls (OR=1.37, 95% CI, 1.26–1.50; adjusted OR=1.38, 95% CI, 1.23–1.56). Adjusting for forced expiratory volume in 1 s had a negligible impact on these associations, but these were attenuated following adjustment for allergic sensitisation, particularly in girls (girls: OR=1.25; 95% CI, 0.96–1.60; boys: OR=1.09, 95% CI, 0.99–1.19). Conclusions: BMI is associated with asthma in pre-pubertal Saudi boys and girls; this effect does not appear to be mediated through respiratory obstruction, but in girls this may at least partially be mediated through increased risk of allergic sensitisation

Ophthalmic Complications of Bariatric Surgery

Obesity is increasing vastly in the world, and the number of bariatric surgeries being performed is also increasing. Patients being submitted to bariatric surgeries, especially malabsorptive procedures, have an increased risk of developing nutrient deficiencies, which can culminate in symptomatic hypovitaminosis, if supplementation is not done correctly. The eye and the optic system need an adequate level of several vitamins and minerals to perform properly, especially vitamin A, and this article wants to cover the main nutrients involved, the possible ophthalmic complications that can arise by their deficiency, and the management of those complications