RESUMO
Roux-en-Y gastric bypass (RYGB) is the most effective treatment for severe obesity. A very low-calorie diet (VLCD) is another effective dietary intervention to treat obesity. This study evaluated the effect of a VLCD versus RYGB on weight reduction, changes in body composition and the resolution of comorbidities during a 12-week period. Individuals with obesity at the obesity clinic, Ramathibodi Hospital, Mahidol University, Thailand with a body mass index (BMI) ≥ 37.5 kg/m2 or ≥32.5 kg/m2 with obesity-related complications were recruited. Treatment options, either RYGB or VLCD, were assigned depending on patients' preferences and physicians' judgment. The analysis included 16 participants in the RYGB group and 15 participants in the VLCD group. Baseline characteristics were similar between groups; nevertheless, the participants in the VLCD group were significantly younger than those in the RYGB group. The number of patients with type 2 diabetes (T2D) was slightly higher in the RYGB group (43.8% vs. 33.3%, p = 0.552). Additionally, patients in the RYGB group had a longer duration of T2D and were treated with anti-diabetic agents, while VLCD patients received only lifestyle modifications. At 12 weeks, total and percentage weight loss in the RYGB and VLCD groups, respectively, were as follows: -17.6 ± 6.0 kg vs. -15.6 ± 5.1 kg (p = 0.335) and -16.2% ± 4.3% vs. -14.1% ± 3.6% (p = 0.147). Changes in biochemical data and the resolution of comorbidities were similar between the groups at 12 weeks. A 12-week VLCD resulted in similar weight loss and metabolic improvement compared with RYGB. Large-scale studies with long follow-up periods are needed to elucidate whether VLCD is a viable alternative treatment to bariatric surgery.
Assuntos
Composição Corporal , Restrição Calórica , Derivação Gástrica , Redução de Peso , Humanos , Derivação Gástrica/métodos , Feminino , Masculino , Restrição Calórica/métodos , Adulto , Pessoa de Meia-Idade , Obesidade/cirurgia , Obesidade/dietoterapia , Obesidade/terapia , Resultado do Tratamento , Diabetes Mellitus Tipo 2/dietoterapia , Índice de Massa Corporal , Obesidade Mórbida/cirurgia , Obesidade Mórbida/dietoterapia , TailândiaRESUMO
Obesity is highly associated with Non-alcoholic fatty liver disease (NAFLD) and increased risk of liver cirrhosis and liver cancer-related death. We determined the diagnostic performance of the complex-based chemical shift technique MRI-PDFF for quantifying liver fat and its correlation with histopathologic findings in an obese population within 24 h before bariatric surgery. This was a prospective, cross-sectional, Institutional Review Board-approved study of PDFF-MRI of the liver and MRI-DIXON image volume before bariatric surgery. Liver tissues were obtained during bariatric surgery. The prevalence of NAFLD in the investigated cohort was as high as 94%. Histologic hepatic steatosis grades 0, 1, 2, and 3 were observed in 3 (6%), 25 (50%), 14 (28%), and 8 (16%) of 50 obese patients, respectively. The mean percentages of MRI-PDFF from the anterior and posterior right hepatic lobe and left lobe vs. isolate left hepatic lobe were 15.6% (standard deviation [SD], 9.28%) vs. 16.29% (SD, 9.25%). There was a strong correlation between the percentage of steatotic hepatocytes and MRI-PDFF in the left hepatic lobe (r = 0.82, p < 0.001) and the mean value (r = 0.78, p < 0.001). There was a strong correlation between MRI-derived subcutaneous adipose tissue volume and total body fat mass by dual-energy X-ray absorptiometry, especially at the L2-3 and L4 level (r = 0.85, p < 0.001). MRI-PDFF showed good performance in assessing hepatic steatosis and was an excellent noninvasive technique for monitoring hepatic steatosis in an obese population.
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Hepatopatia Gordurosa não Alcoólica , Humanos , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Prótons , Estudos Prospectivos , Estudos Transversais , Fígado/diagnóstico por imagem , Fígado/patologia , Imageamento por Ressonância Magnética/métodos , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/patologia , BiópsiaRESUMO
INTRODUCTION: Endoscopic self-expandable metal stent (SEMS) placement is the key endoscopic treatment for unresectable malignant biliary obstruction. The benefit of covered SEMS over uncovered SEMS remains unknown as are risk factors for SEMS dysfunction. This study aimed to determine the factors associated with patency of SEMS. METHODS: Patients with unresectable malignant biliary obstruction who underwent endoscopic SEMS placement at Ramathibodi Hospital, during January 2012 to March 2021 were included. Patient characteristics, clinical outcomes and patency of SEMS were collected. The primary outcome were stent patency and factors associated with patency of SEMS. The factors were analyzed by univariate and multivariate analyses. Median days of stent patency, median time of patient survival, rate of reintervention and complications after SEMS placement were collected. RESULTS: One hundred and fourteen patients were included. SEMS dysfunction was found in 37 patients (32.5%). Size of cancer (Hazard ratio (HR), 1.20, (95% CI 1.02, 1.40), p 0.025), presence of stones or sludge during SEMS placement (Hazard ratio (HR), 3.91, (95% CI 1.74, 8.75), p 0.001), length of SEMS, 8 cm (HR 2.96, (95% CI 1.06, 8.3), p 0.039), and total bilirubin level above 2 mg/dL at one month after SEMS placement (HR 1.14, (95% CI 1.06, 1.22), p < 0.001) were associated with SEMS dysfunction. The median stent patency was 97 days. The median patient survival was 133 days, (95% CI 75-165). The rate of reintervention was 86% in patients with SEMS dysfunction. CONCLUSION: The size of cancer, presence of stones or sludge during SEMS placement, the length of SEMS, and total bilirubin level above 2 mg/dL at 1 month after SEMS placement were associated with SEMS dysfunction. The median time of stent patency were not statistically different in each type of stent, covered stent, partially covered stent and uncovered stent. Median survival time of patients did not associate with SEMS patency or dysfunction.
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Colestase , Neoplasias , Stents Metálicos Autoexpansíveis , Humanos , Esgotos , Resultado do Tratamento , Colestase/etiologia , Colestase/cirurgia , Neoplasias/complicações , Stents Metálicos Autoexpansíveis/efeitos adversos , Stents/efeitos adversos , Bilirrubina , Estudos RetrospectivosRESUMO
Background Metabolic-associated fatty liver disease (MAFLD) is increasingly common among people living with the human immunodeficiency virus (PLHIV) and can progress to cirrhosis and cirrhotic-related complications. Pioglitazone is known to improve insulin sensitivity that results in decreasing serum fatty acids and resolution of non-alcoholic steatohepatitis. This study was aimed to evaluate the efficacy of pioglitazone for the treatment of MAFLD in PLHIV and prediabetes. Methods A randomized controlled trial was conducted in HIV-positive individuals with prediabetes who had evidence of a fatty liver by abdominal ultrasonography or controlled attenuation parameter (CAP) ≥ 238 decibels per meter (dB/m) through using transient elastography. Participants were randomized to take pioglitazone, 30 mg/day, (pioglitazone group) or placebo (control group) and were followed up and assessed for 48 weeks. Results A total of 98 participants were enrolled, 49 in each group. The mean age was 50.8 years and 66.3% were males. All participants had received antiretroviral therapy with undetectable HIV ribonucleic acid (RNA) and the mean CD4 cell count was 463.2 cells/mm3. The mean baseline CAP and liver stiffness were 285.7 dB/m and 5.4 kilopascals (kPa), respectively. At 24 weeks, the mean change of the CAP level was -25.7 dB/m in the pioglitazone group and -5.6 dB/m in the control group (p = 0.040); the mean change of liver stiffness was 0.014 kPa in the pioglitazone group and 0.403 kPa in the control group (p = 0.199). At 48 weeks, the mean change of the CAP level was -23.5 dB/m in the pioglitazone group and 10.2 dB/m in the control group (p < 0.001); the mean change of liver stiffness was -0.184 kPa in the pioglitazone group and 0.554 kPa in the control group (p = 0.016). The mean changes of fasting plasma glucose (FPG) at 24 and 48 weeks were -14.9 and -17.5 mg/dL in the pioglitazone group, respectively, and -3.6 and 4.5 mg/dL in the control group, respectively (p < 0.05). The mean change of the body mass index, lipid profiles, and liver enzymes were not different between the two groups at both time points (p > 0.05). No serious adverse effects were observed in either group. Conclusions Pioglitazone significantly reduces CAP, liver stiffness, and FPG in PLHIV with prediabetes and MAFLD. Further studies with long-term follow-up duration are warranted to determine the role of pioglitazone for clinical use in this population.
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INTRODUCTION: Gastroesophageal reflux plays a significant role in idiopathic pulmonary fibrosis (IPF). Given the morbidity and mortality associated with IPF, understanding the mechanisms responsible for reflux is essential if patients are to receive optimal treatment and management, especially given the lack of clear benefit of antireflux therapies. Our aim was to understand the inter-relationships between esophageal motility, lung mechanics and reflux (particularly proximal reflux-a prerequisite of aspiration), and pulmonary function in patients with IPF. METHODS: We prospectively recruited 35 patients with IPF (aged 53-75 years; 27 men) who underwent high-resolution impedance manometry and 24-hour pH-impedance, together with pulmonary function assessment. RESULTS: Twenty-two patients (63%) exhibited dysmotility, 16 (73%) exhibited ineffective esophageal motility (IEM), and 6 (27%) exhibited esophagogastric junction outflow obstruction. Patients with IEM had more severe pulmonary disease (% forced vital capacity: P = 0.032) and more proximal reflux (P = 0.074) than patients with normal motility. In patients with IEM, intrathoracic pressure inversely correlated with the number of proximal events (r = -0.429; P = 0.098). Surprisingly, inspiratory lower esophageal sphincter pressure (LESP) positively correlated with the percentage of reflux events reaching the proximal esophagus (r = 0.583; P = 0.018), whereas in patients with normal motility, it inversely correlated with the bolus exposure time (r = -0.478; P = 0.098) and number of proximal events (r = -0.542; P = 0.056). % forced vital capacity in patients with IEM inversely correlated with the percentage of reflux events reaching the proximal esophagus (r = -0.520; P = 0.039) and inspiratory LESP (r = -0.477; P = 0.062) and positively correlated with intrathoracic pressure (r = 0.633; P = 0.008). DISCUSSION: We have shown that pulmonary function is worse in patients with IEM which is associated with more proximal reflux events, the latter correlating with lower intrathoracic pressures and higher LESPs.
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Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/fisiopatologia , Idoso , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função RespiratóriaRESUMO
The management of dyspepsia in limited-resource areas has not been established. In 2017, key opinion leaders throughout Thailand gathered to review and evaluate the current clinical evidence regarding dyspepsia and to develop consensus statements, rationales, levels of evidence, and grades of recommendation for dyspepsia management in daily clinical practice based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline is mainly focused on the following 4 topics: (1) evaluation of patients with dyspepsia, (2) management, (3) special issues (overlapping gastroesophageal reflux disease/irritable bowel syndrome and non-steroidal anti-inflammatory drug/aspirin use), and (4) long-term follow-up and management to provide guidance for physicians in Thailand and other limited-resource areas managing such patients.
RESUMO
BACKGROUND: Although cut-off values used in high-resolution manometry (HRM) to diagnose esophageal motility disorders are based on representative samples of the US population and assume a supine position, differences in population and body positioning can reportedly affect results. AIMS: To establish normal HRM values for Thai people in both supine and upright positions. METHODS: Forty-one healthy subjects were recruited, each of whom underwent solid-state HRM with ten 5-mL swallows of water in both the supine and upright positions. Measuring parameters according to the Chicago classification criteria (CC v3.0) were included, for which the mean, median and 5th and 95th percentiles (PCTLs) were calculated. RESULTS: The results corresponded with the CC v3.0 criteria, except for the mean, and 5th PCTL of the distal contractile integral (DCI), which were lower for this population. In the upright position, the mean and median values for DCI, intrabolus pressure and integrated relaxation pressure were significantly decreased, whereas the length of the transitional zone was significantly increased. The limitations of this study include: (1) the relatively low number of participants, (2) the limited recruitment of participants only at Ramathibodi Hospital and (3) the limited recruitment of only young and middle-aged participants. CONCLUSIONS: We established normal values for the HRM parameters in a representative sample of the Thai population. Our supine results still prove that the use of the CC v3.0 is preferable. HRM testing in patients measured in the upright position should be analyzed based on the normative values obtained from upright swallow studies.