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Biomedical subjects

R E Barry

Publications and source records attributed to R E Barry.

At least 55 records · Page 3Linked to original sources
PubMed1976

Intestinal bypass surgery for obesity decreases food intake and taste preferences.

Food intake was measured in 22 obese patients before and after jejunioleostomy for obesity. Most of the weight loss could be accounted for by the observed reduction of caloric intake. Malabsorption was also present as indicated by increased loss of fat in the stools, and decreased absorption of D-xylose and vitamin B12. A dislike for sweet tastes developed after surgery in most patients. Preferences for concentrated solutions of sucrose and glucose were reduced after patients showed a depression of food intake by a 440-calorie preload which had not been detected before surgery. These studies show a decrease in food intake after intestinal bypass surgery and suggest a role for taste or other gastrointestinal factors in regulating food intake.

Adult↗
PubMed1976

Experience with jejunoileal bypass for obesity.

Fifty-eight patients less than 30 years old but who are more than 300 pounds in weight were considered for investigation of jejunoileal bypass. Thirty patients had operations, and the functioning bypass included 40 centimeters of jejunum and 10 centimeters of ileum. In 14 patients, intestinal continuity was restored by either end-to-end or end-to-side anastomosis according to random choice, and in 16 patients, end-to-end anastomoses were used. At present, the follow-up period is one to four years, and the weight loss, so far, has not been significantly related to the type of reconstruction used. Weight loss correlated possitively with the preoperative weights up to one year after operation. Also, weight loss correlated positively with the total measured length of the small intestine during the first six postoperative months, but this correlation currently is showing a trend toward negativity. Food intake decreased by 2,682+/-690 calories per day at six months after operation as a result of the bypass. Chronic acidosis was common. Results of an endocrine evaluation revealed an unexpected significant decrease in parathormone levels within the normal range. A new complication, colonic pseudo-obstruction, has occurred one year or more after operation in five patients or 17 per cent of our group. This complication is related to the intestinal anaerobic flora in proximity of the defunctionalized limb; its symptoms and signs can be alleviated by giving antibiotics or Lactobacillus to change the intestinal flora. Although 90 per cent of our patients are pleased with their progress and the results of routine evaluation corroborate their satisfaction, detailed analysis of the research data available to us revealed that only 43 per cent have had beneficial effects from a jejunoileal bypass without any of the serious sequelae. We consider jejunoileal bypass for obesity justified when carried out by interdisciplinary groups dedicated to the long term follow-up study of the patient and periodic reporting of the results. The long term future for the operation is, as yet, not completely understood, and when the conditions we have recommended are not present, we cannot currently endorse the operation.

Adult↗
PubMed1975

Detection of continuing gluten ingestion in treated coeliac patients.

To assess the incidence and effects of continuing gluten ingestion in coeliac disease 51 adult coeliac patients were studied after four to 132 (mean 63) months on a prescribed gluten-free diet. Each patient completed a prospective dietary questionnaire, underwent a repeat jejunal biopsy, and gave serum for gluten antibody estimation. Altogether 65% of patients were still ingesting gluten, often inadvertently. Direct questioning on dietary habits had failed to uncover most of this consumption. The gluten antibody test proved a useful screening test for detecting continuing gluten ingestion and patients with both persistent subtotal villous atrophy and gluten antibodies were almost certain to be taking large amounts ( more than 2 g/day). The presence of persistent partial villous atrophy was found, however, to be an unreliable guide to gluten intake.

Adolescent↗
PubMed1975

Colonic pseudo-obstruction: a new complication of jejunoileal bypass.

Five female patients ranging in age from 25 to 44 years are reported in whom jejunoileal bypass (three end-to-side and two end-to end), performed for morbid obesity, was complicated 1 1/2 to three years later by symptoms of colonic pseudo-obstruction. In each size, the colon was markedly elongated, dilated, and atonic but with no demonstrate organic obstruction. The cause of this complication is not known. Full thickness rectal biopsy in one case showed normal intrinsic nervous plexuses and ganglia. Serum electrolytes were normal. Functional and defunctionalized small bowel were not involved. Symptoms varied from complete colonic paralysis to incapacitating crampy abdominal pain and distention. In the three patients with end-to-side bypass, dilatation affected the entire colon, while, in the two patients with end-to-end bypass, the dilatation was localized to colon distal to the anastomosis with the defunctionalized small bowel. Resection of the affected portion of colon in one case resulted in recurrence distal to the new site of drainage of defunctioned bowel. Treatment with anti-anaerobe antibiotics in two cases produced dramatic but temporary relief of symptoms.

Adult↗
PubMed1974

Malignancy, weight loss, and the small intestinal mucosa.

The mucosal architecture and mucosal dynamics of the small bowel have been studied in patients with malignant disease not of the gastrointestinal tract but associated with severe weight loss. Mucosal changes in malignant disease are demonstrated by stereomicroscopy, mucosal architectural measurement, and decreased lactose utilization. Measurement of the epithelial DNA loss rate indicates, in association with mucosal measurement, that the architectural changes are caused by a hypoplasia of the epithelium. Similar findings are demonstrated in patients with profound weight loss due to other non-malignant wasting diseases. Although mucosal changes undoubtedly occur in malignant disease, the changes are not specific for malignancy and the concept of ;cancer enteropathy' is not tenable. It is suggested that mucosal changes are the effect of and not the cause of cachexia.

Autopsy↗
PubMed1971

Mucosal architecture of the small bowel in cases of psoriasis.

Using a strictly defined grading system to eliminate subjective assessment of mucosal architecture, the jejunal mucosa from cases of extensive psoriasis has been shown to be significantly different from that of normal controls obtained both in life and at postmortem examination. The same changes, however, are shown to occur in patients who are ill and losing weight for reasons other than psoriasis. Diminshed lactose utilization, demonstrated in extensive psoriasis, supports the suggestion of a decreased mucosal surface area in this disease.

Autopsy↗
PubMed1970

A case of small-intestinal mucosal atrophy.

A patient is described with a severe malabsorption syndrome which failed to respond to a gluten-free diet. Although subtotal villous atrophy was present in the jejunal mucosa, histological features of subepithelial fibrosis and apparently normal enterocytes were not suggestive of coeliac disease. The findings of decreased mucosal thickness, of a normal mitotic rate in the crypt cell population, and of the decreased rate of loss of epithelial cells further suggested that the disease process producing the ;flat' mucosa was not that of coeliac disease. The condition was complicated by ileal ulceration and active tuberculosis.

Atrophy↗