Octavia Pickett-Blakely

Sociodemographic Trends in Bariatric Surgery Utilization in the USA

Although bariatric surgery has become more accessible in recent years, it is unclear whether populations disproportionately affected by obesity are utilizing this treatment. A cross-sectional analysis of the Nationwide Inpatient Sample was performed. The sociodemographic characteristics (race, sex, age, insurance, median income), co-morbidities, and weight loss surgery type were analyzed. Bariatric surgeries increased six-fold from 17,678 in 1998 to 112,882 in 2004 (p < 0.001). Thereafter, bariatric surgeries declined to 93,733 in 2007 (p = 0.24). The proportion of individuals of Other race undergoing bariatric surgery significantly increased, while the proportion of Whites significantly decreased over time. The proportion of individuals in the lowest income quartile (<

Patient-Physician Gender Concordance and Weight-Related Counseling of Obese Patients

25,000) increased, while those in the highest income percentile (>

Barrett's esophagus: histology and immunohistology

45,000) decreased. From 1998 to 2007, the sociodemographic characteristics of the bariatric surgery population have changed, although those that are disproportionately affected by morbid obesity continue to be underrepresented.

De Novo Inflammatory Bowel Disease After Bariatric Surgery: A Case Series and Literature Review

BACKGROUND Obesity affects approximately one third of Americans. Patient and provider characteristics such as gender may influence obesity care. Gender concordance has been associated with clinical practice patterns in chronic conditions such as hypertension and diabetes, but its role in obesity care is unknown. PURPOSE The purpose of this study was to investigate the association of patient-physician gender concordance with weight-related counseling among obese adults. METHODS A cross-sectional study using the 2005-2007 National Ambulatory Medical Care Survey was conducted in 2010. Postvisit data from the clinical encounters of 5667 obese individuals and their physicians were analyzed to determine the association between patient-physician gender concordance (categorized using patient gender as the reference point as female gender-concordant, male gender-concordant, male gender-discordant, and female gender-discordant) and three types of weight-related counseling (diet/nutrition, exercise, and weight reduction). RESULTS Diet/nutrition, exercise, and weight reduction counseling was provided to 30%, 23%, and 20% of obese patients, respectively. Patients in male gender-concordant patient-physician pairs had significantly higher adjusted odds of receiving diet/nutrition (OR=1.58, 95% CI=1.05, 2.40) and exercise counseling (OR=1.76, 95% CI=1.13, 2.74) than female gender-concordant pairs. There were no significant differences in any form of weight-related counseling between female gender-concordant and gender-discordant pairs. CONCLUSIONS The findings of this study suggest that male patient-physician gender concordance is positively associated with diet/nutrition and exercise counseling.

Going Gluten Free: the History and Nutritional Implications of Today’s Most Popular Diet

The following on histology and immunohistology of Barretts esophagus (BE) includes commentaries on the various difficulties remaining in reaching a consensus on the definition of BE; the difficulties in the characterization of intestinal and cardiac mucosa, and in the role of submucosal glands in the development of BE; the importance of a new monoclonal antibody to recognize esophageal intestinal mucosa; the importance of pseudo goblet cells; the best techniques for the endoscopic detection of Barretts epithelium; and the biomarkers for identification of patients predisposed to the development of BE.

Lactulose Hydrogen Breath Test Result Is Associated with Age and Gender

Paralleling the alarming rise in rates of obesity and obesityrelated comorbid conditions in the USA, the number of bariatric surgeries continues to increase in recent years, according to the American Society for Metabolic and Bariatric Surgery. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries in the USA. The two main mechanisms for weight loss with RYGB involve a combination of food restriction and bypass of absorptive and secretory components of the digestive tract. While the aforementioned mechanisms are effective in both induction and maintenance of sustained weight loss, unfortunately, they can lead to various complications as well. Such complications may be predominantly nutritional (micronutrient and macronutrient deficiencies, dehydration) or gastrointestinal (diarrhea, nausea, vomiting, abdominal pain, ulcers, strictures, gallstones, hernias) in nature [1]. To date, there have been only seven reported cases in the literature of new onset Crohn’s disease (CD) after gastrointestinal bypass surgery [1–4]. We present two cases of new onset CD after RYGB.

Future Therapies in Obesity

Purpose of ReviewThe gluten-free diet (GFD) has become one of the most popular diets in modern history. Claims of improved health and increased energy fuel this popularity, though there is little evidence to substantiate these claims. The present review focuses on outlining known gluten-related disorders (GRD), discussing the GFD in the general population, exploring nutritional considerations, and providing advice for physicians in managing these patients.Recent FindingsCurrently, about a quarter of the population reports keeping a GFD despite GRDs affecting less than half of these individuals. Reduced intake of calcium, B vitamins, and fiber as well as enhanced consumption of fat and simple carbohydrates has consistently been reported and needs to be continually addressed.SummaryAlthough a necessity in proper management of GRDs, unforeseen nutritional complications may develop in patients who are gluten free for which enhanced physician awareness is vital to achieving optimal patient care.

Endoscopy Unit Considerations in the Care of Obese Patients

Small intestinal bacterial overgrowth (SIBO) is associated with chronic gastrointestinal diseases and structural/functional abnormalities of the gastrointestinal tract. SIBOs association with clinical characteristics is unclear. This study investigates the association between clinical factors and SIBO according to lactulose hydrogen breath test (LHBT) result. Methods. A cross-sectional study in a university-based gastroenterology practice was performed. Data was abstracted from the medical records of subjects undergoing LHBT from 6/1/2009 to 6/1/2013. Logistic regression analysis was performed to determine the association between predictor variables: age, sex, body mass index (BMI), and positive LHBT, the outcome of interest. Results. LHBT was performed in 791 subjects. Fifty-four percent had a positive LHBT. There was no statistically significant difference between the LHBT results according to age or BMI. In females, the likelihood of a positive LHBT increased with age (OR 1.02; 95% CI: 1.01–1.03). In males, the likelihood of a positive LHBT result decreased with age (OR 0.98; 95% CI: 0.97–1.00). Conclusion. There was an association between age, with respect to sex, and a positive LHBT. With increased age in females, the odds of a positive LHBT increased, while, in men, the odds of a positive LHBT decreased with age.

Achalasia Patients Are at Nutritional Risk Regardless of Presenting Weight Category

Although diet and exercise have been the cornerstone of therapy for obesity, efficacy is suboptimal and short lived. Surgical procedures are durable but invasive therapy for obesity. Supplemental therapies for obesity that are minimally invasive, low risk, and effective are needed. Several therapeutic options are being developed that offer obese patients and their health care providers alternatives to what is currently available.

Micronutrients in Nonalcoholic Fatty Liver Disease Pathogenesis

The dramatic increase in obesity in the general population is accompanied by a concomitant increase in bariatric surgical programs. Gastrointestinal endoscopy has an important role in patient evaluation, postoperative management, and emerging endoscopic bariatric therapies. Endoscopy units must address special design and equipment needs of obese patients in short- and long-range planning. Obese people require more health care resources than nonobese people, with increased physical challenges for staff in administering that care. This article details endoscopy unit considerations pertaining to the bariatric patient, which may apply to pretreatment endoscopic evaluation, managing postoperative bariatric surgical complications, and emerging endoluminal bariatric therapies.