Bariatric Times

NOV 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C l i n i c a l D e v e l o p m e n t s a n d M e t a b o l i c I n s i g h t s i n T o t a l B a r i a t r i c P a t i e n t C a r e Volume 14, Number 11 November 2017 A P e e r - R e v i e w e d P u b l i c a t i o n Presorted Standard U.S. Postage PAID Lebanon Junction, KY Permit #344 ITunes Google (Android) Download the BT app for your mobile device! Scan this QR code with your QR reader for the digital edition of Bariatric Times. Inside EDI TORI AL MES S AGES . . . . . . . . . . . . . . . . 3 A Message from Dr. Raul J. Rosenthal: A wa r d s , U p d a t e s , R e v i e ws ...a n d a F o n d F a r e we l l A Message from Dr. C hristopher S till: I t 's T i me t o Ch a n g e t h e W a y W e Ca r e —Ta k e 5 a n d J o i n U s f o r N a t i o n a l O b e s i t y Ca r e W e e k 2 0 1 7 ! R EV IEW . .... .... ..... .... .... ..... .... .... .1 0 N e u r oh or mon al In f l u e n c e s on Ob e s i t y R EV IEW . .... .... ..... .... .... ..... .... .... .1 6 Small Intestine Bacterial Growth in Modern Bariatric Surgery SPOTLIGHT .... ..... .... .... ..... .... .... .20 ASMBS State Chapter Spotlight: Florida, Puerto Rico, and the Caribbean ASK THE LEADERSHIP . ..... .... .... .22 John Morton, MD, MPH, FACS, FASMBS: Obesity PAC Update ASMBS FOUNDATION UPDATE .. .25 LEAD Awards NEWS AND TRENDS . . . . . . . . . . . . . . . . . 27 Page 10 Page 16 Small Intestinal Bacterial Overgrowth in Modern Bariatric Surgery R EVIEW by DIANA MIAO, BA INTRODUCTION Bariatric surgery has been shown to promote weight loss and slow or reverse progression of comorbid conditions, such as diabetes, obstructive sleep apnea, hyperlipidemia, and hypertension, in adults and adolescents. 1,2 In comparison to restrictive bariatric procedures (gastric sleeve, gastric balloon, gastric band), the malabsorptive procedures (Roux- en-Y gastric bypass [RNYGB], jejunoileal bypass [JIB], biliopancreatic switch) are associated with greater weight loss but can also lead to idiosyncratic complications due to the creation of blind loops of the small bowel, which can be sites for small intestinal bacterial overgrowth (SIBO) (Figure 1). The small intestine normally harbors fewer than 10 3 bacteria/mL, and SIBO is defined as small intestinal bacterial populations exceeding 10 5 to 10 6 bacterial organisms/mL. SIBO develops in a variety of clinical conditions involving gastric acid suppression, disordered gastrointestinal motility, and/or structural abnormalities of the gastrointestinal tract, all of which are permissive for bacterial proliferation. 3 REVIEW INTRODUCTION Regulation of appetite and food intake is mediated by the gut-brain axis, in which several gut hormones and neuropeptides travel, either directly through the blood brain barrier or indirectly via vagus nerve currents. This intricate circuitry between the gut and brain centers such as the dorsal vagal complex and the hypothalamus controls appetite, gastric motility, and satiety. Neuropeptide pathways originate from three systems/responses: 1) adipose tissue, 2) gut response to nutrient sensing from food, and 3) gut response to mechanical stretch from food. These pathways carry appetite-related signals to the brain. 1 Variations in levels of these neuropeptides between individuals with obesity and individuals with normal weight have been identified. This research has led to the development of drugs and devices that attempt to modulate various pathways in this interrelated neuropeptide signaling scheme in individuals with obesity. Bariatric surgery has been shown to have a variable, yet sometimes drastic and sustainable, impact on levels of key peptides, such as ghrelin, leptin, and glucagon-like peptide-1 (GLP-1). 2 To date, most research on the epigenetics of obesity has focused on peptide signaling that influences appetite and food intake rather than energy expenditure. The key appetite- regulating neuropeptides will be explored herein. by APRIL SMITH, PharmD, MA, BCPS Neurohormonal Influences on Obesity Follow us.

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