Esophageal pH and impedance reflux parameters in relation to body mass index, obesity-related hormones, and bariatric procedures.

Introduction Obese patients have a higher risk of gastroesophageal reflux disease (GERD), but obesity­related hormonal changes associated with GERD and the effects of bariatric therapy on reflux are unclear. Objectives The aim of the study was to assess reflux parameters in relation to bariatric therapy and hormonal changes in obese patients. Patients and methods This prospective observational study with a 1­year follow­up included 53 obese patients undergoing bariatric therapies. Esophageal pH and impedance monitoring tests were performed and circulating hormone levels were analyzed. Results Esophageal acid exposure time (%AET) and the number of refluxes correlated positively with body mass index. There were several significant, although weak, correlations of pH and impedance parameters with ghrelin and omentin levels. Patients with abnormal %AET had lower ghrelin levels and those with abnormal reflux number had lower omentin levels than patients with normal parameters. Although we observed certain changes including increased %AET and bolus clearance time (BCT) after laparoscopic sleeve gastrectomy, a reduced BCT and number of refluxes after gastric band, and nonsignificant changes after intragastric balloon, the overall bariatric therapy did not significantly impact on the final GERD diagnosis. GERD before and after therapy was present in 42% of patients. De novo GERD developed in 17.8% of patients, while a similar percentage of patients with initial GERD had normal pH and impedance after therapy. Patients with de novo or persistent GERD had a similar percentage of weight loss as patients without GERD. Conclusions Bariatric therapy and percentage of weight loss do not significantly affect GERD. The observed hormonal changes alone do not fully explain the high prevalence of GERD in obese patients.

Oxidative Modification of Biomolecules in the Nonstimulated and Stimulated Saliva of Patients with Morbid Obesity Treated with Bariatric Surgery.

Morbid obesity leads to progressive failure of many human organs and systems; however, the role of oxidative damage to salivary composition is still unknown in the obese patients. In this study, we assessed the effect of bariatric surgery on oxidative damage in nonstimulated (NS) and stimulated (S) whole saliva. The study included 47 subjects with morbid obesity as well as 47 age- and gender-matched healthy volunteers. Oxidative modifications to lipids (4-hydroxynonenal (4-HNE) and 8-isoprostanes (8-isoP)), proteins (advanced oxidation protein products (AOPP) and protein carbonyl groups (PC)), and DNA (8-hydroxy-D-guanosine (8-OHdG)) were analyzed in morbidly obese patients before and after bariatric surgery as well as in the healthy controls. The concentrations of 8-isoP, AOPP, PC, and 8-OHdG were significantly higher in both NS and S of patients with morbid obesity than in the control patients and compared to the results obtained 6 months after bariatric surgery. The levels of oxidative damage markers were also higher in S versus NS of morbidly obese patients. In summary, morbid obesity is associated with oxidative damage to salivary proteins, lipids, and DNA, while bariatric treatment generally lowers the levels of salivary oxidative damage.

Surgical management in parenchymatous organ injuries due to blunt and penetrating abdominal traumas--the authors' experience.

BACKGROUND: Social developments have brought increases in both motorization and violence worldwide, including in Poland, which has meant a steady increase in the percentage of multi-organ injuries, including abdominal, spleen and liver injuries. As a result of these injuries, the number of deaths from hemorrhagic shock is constantly growing. MATERIAL AND METHODS: The study presents 126 patients hospitalized after blunt and penetrating abdominal parenchymatous organ traumas over a 10-year period (2000-2010). RESULTS: The majority of parenchymatous organ traumas in the study period resulted from traffic accidents. The examined group included cases of liver injury, spleen injury and simultaneous liver and spleen damage. Among liver and spleen injuries, the most frequent was parenchymal rupture. A variety of surgical procedures were applied, including laparoscopy used as both a diagnostic and therapeutic method. Among the 126 patients hospitalized after parenchymatous organ traumas, nine died. CONCLUSIONS: Parenchymatous organ injuries after abdominal traumas are a very important surgical issue nowadays. Laparoscopy is increasingly frequently applied both as a diagnostic and therapeutic and technique. Due to the accessibility of highly specialized imaging diagnostics, observation and conservative treatment in spleen injuries is now possible.