Miguel Ángel Rubio Herrera

Metabolic surgery: Quo Vadis?

The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed.

Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases

In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI) within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

Update on pharmacology of obesity: Benefts and risks

The prevalence of obesity in Western countries has increased at a much greater pace than the development of new efficient and safe drugs, beyond mere lifestyle changes, for the treatment of overweight. Numerous different types of drugs which had been used in the past for the treatment of obesity have currently been withdrawn due to undesirable long-term side effects. The only available drug in Europe is orlistat, which serves only as an aid for the treatment of obesity. In the USA, however, a few central adrenergic-mediators, for instance, diethylpropion and phentermine, have been available for decades to treat obesity during a short-term period (less than 12 weeks). The Food and Drug Administration (FDA) has recently approved lorcaserin and the combination phentermine/ topiramate for the treatment of obesity. The first one is a selective serotonin 2C receptor agonist that works by decreasing food intake with few side effects. Its outcomes on weight are modest, but may be helpful in certain selected patients. The phentermine/topiramate combination has proved to be highly effective, achieving a 10% reduction in weight in the majority of patients, although attention must be drawn to the possible development of side effects in both the short and the long-term follow-up. Further investigation regarding the mechanisms involved in weight balance will anticipate the development of new expectations for the treatment of obesity in the near future.

Severe vitamin A deficiency after malabsortive bariatric surgery

Vitamin A deficiency may occur after malabsorptive bariatric surgery. However, it rarely entails important functionally limiting symptoms. We present the case of a woman who underwent bariatric surgery and developed ocular dryness, xeroderma and hearing loss due to severe vitamin A deficiency. We illustrate an outstanding and exceptional case of the consequences of an excessive and uncontrolled malabsorption.

Dermatitis and optic neuropathy due to zinc deficiency after malabsortive bariatric surgery

We present a patient who underwent successful classic duodenal switch and developed a marked dermatitis with a significant functional limitation. This is an unusual complication, despite the relatively moderate prevalence of nutrient deficiency after this type of bariatric surgery. We discuss possible pathogenic mechanisms and emphasize the importance of an appropriate nutritional management.

Squamous Cell Carcinoma of the Peristomal Skin of a Gastrostomy: Case Study

BACKGROUND: Primary skin tumors that develop at enteral feeding stomas are extremely rare. Ongoing surveillance of these stomas, including the peristomal skin, is essential to early diagnosis and treatment of these tumors. CASE: A 73-year-old man with an esophageal chemical burn caused by swallowing sodium hypochlorite (bleach) approximately 50 years earlier that was initially managed with esophageal exclusion and placement of a gastrostomy device for enteral feeding presented with an exophytic and painful mass of the skin adjacent to his gastrostomy site. The pathologic report confirmed differentiated squamous cell skin carcinoma. CONCLUSION: Skin tumors arising from chronic wounds or ulcers of the skin surrounding a gastrostomy device are rare but should be considered if hypergranulation tissue or a peristomal lesion appears to be nonhealing. WOC nurses are frequently consulted for care of granulomas, and close monitoring is essential for avoiding this potentially fatal complication.

Helicobacter Pylori (HP) infection in obese patients undergoing Roux-en-Y gastric bypass: efficacy of two different treatment regimens in HP eradication

INTRODUCTION the ultimate cause for the increased incidence of gastric ulcer following Roux-en-Y gastric bypass (RYGB) remains unclear. Treatment of HP infection is recommended before surgery in countries with high prevalence such as Spain in other to diminish the risk. However, the current regimens used might not be adequate in view of the high failure rate for HP eradication. METHODS we reviewed 243 patients retrospectively undergoing RYGB and found 111 patients (45%) with HP infection. Therefore, we compared the eradication rate between 2 different regimens. RESULTS 70 patients received OCA(Omeprazole:20 mg/12h, Clarithromycin 500 mg/12h and Amoxicillin 1 gram/12h for 10 days) while 41 patients received OLA (Omeprazole 20 mg/12 hours, Levofloxacin 500 mg/12hours and Amoxicillin 1 gram/12h for 10 days) for HP eradication. In 56/70 (80%) patients receiving OCA therapy HP was eradicated compared to 37/41 (91%) receiving OLA as first line therapy (p = 0.283). When used as second line therapy, in 13/14 (92%) patients receiving OLA HP was eradicated. CONCLUSION clarithromycin resistance remains a matter of concern in this population while OLA seems to be a good alternative therapy for HP eradication, especially when OCA regimen fails.