Ulcerogenesis Following Gastric Procedure for Obesity.
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Biomedical subjects
CL Birmingham
Publications and source records attributed to CL Birmingham.
Helicobacter pylori-induced Diarrhea Ileogastrostomy.
A retrospective study of all ileogastrostomy procedures (n = 26) performed in 1993 by one surgeon (IGMC) was carried out to investigate the hypothesis that Helicobacter pylori may be implicated in certain severe cases of postoperation nausea and diarrhea. Ten of 26 persons (38.5%) displayed nausea and notable diarrhea (greater than or equal to ten bowel movements per day), seven of which warranted upper GI investigation. One hundred per cent (seven of seven) of these persons were found to possess H. pylori upon C-14 breath test. In four of six cases eradication therapy (1 g amoxicillin b.i.d./20 mg omeprazole b.i.d. for 2 weeks) corresponded with a resolution of severe nausea and diarrhea (one additional case involved omeprazole use only), suggesting that H. pylori should be considered as a possible cause of these symptoms post-ileogastrostomy. Additionally, in four of seven cases persons were re-tested (C-14 breath analysis) at least 1 month post-therapy and in this group three persons were found to be free of the organism. All three cases of notable diarrhea and nausea resolved with treatment, providing the strongest evidence for a possible association between infection and these symptoms.
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The Mechanism of Weight Loss after Ileo-gastrostomy for Morbid Obesity.
Twelve patients (weight 107-178 kg and age range 19-43 years) were investigated following ileo-gastrostomy for morbid obesity. A number of variables were studied prospectively, pre- and postoperatively, to determine the cause of weight loss-previously attributed to malabsorption or decreased caloric intake. Weight loss of 10.9-36.5 kg, mean 22.9 kg, occurred. Three-day calorie counts demonstrated a postoperative decrease in daily caloric consumption of 320-3870, mean 1975 cal. Analysis of body compartment composition after derivation of lean body mass (from calculation of total body water with tritiated water) showed a mean decrease in adipose tissue of 17.7 kg. Postoperative weight loss, mainly fat, could not all be accounted for by decreased caloric consumption or steatorrhea (72-h stool fat increased by a mean of 30 g). Pulmonary studies showed no significant change in respiratory quotient, but a large decrease in both postoperative utilization of oxygen and the production of carbon dioxide. This may indicate an alternate, anaerobic, energy cycle utilization. Other statistically significant variables included a large fall in cholesterol, LDH cholesterol and triglycerides, and smaller decrease in HDL cholesterol. Changes in gastro-intestinal (GI) hormones and cell counts in stomach and small intestine were also measured and will be reported later.
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Gastric Banding for Morbid Obesity: the St Paul's experience.
A group of 300 consecutive morbidly obese patients who underwent a gastric banding procedure (gastric segmentation) by a single surgeon (F.S.W.) has been analyzed as to their sex, age, hospitalization, complications and sequelae, reversal or reoperation, and weight loss. The time frame was born August 1984 to January 1991. Eighty-eight percent were females and the average age was 37 years. The operative mortality was zero, and the complications were minor (1%). Eight women have had one or more normal pregnancies after the operation. Thirty-eight cases (12.7%) have had a reversal or a reoperation. Thirty-one patients (10.3%) were lost to follow-up. 271 cases have been operated on for more than 1 year and up to 6.5 years. In those patients not lost to follow-up or who have not had a reoperation, 109 or 54% had a weight loss of 30% or more and 140 or 68% had a weight loss of 25% or more. We conclude that in our setting, the gastric banding is successful in promoting weight loss with a minimum risk and an acceptable reoperation or reversal rate.
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