Jejunoileal Bypass For Obesity Research Articles

Excluded loop syndrome: a complication of jejuno-ileal bypass for obesity.

Excluded loop syndrome may develop in patients who undergo jejuno-ileal bypass surgery with the excluded small intestine drained via an ileosigmoidostomy. A unique case of a morbidly obese male who underwent the procedure while on methadone maintenance therapy is presented. The major factor in the development of this disorder appears to be the high intraluminal pressures within the sigmoid colon which prevent adequate egress from the excluded loop. Narcotic medications tend to induce or intensify the syndrome.

Importance of small bowel peptides for the improved glucose metabolism 20 years after jejunoileal bypass for obesity.

Obese patients operated with jejunoileal bypass (JIB) have reduced plasma concentrations of insulin and glucose. Gastric inhibitory peptide/glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) have been found to have a profound incretin effect in humans. The aim of the present study was to examine the long-term effect of JIB on glucose metabolism. Four groups (lean, nonoperated obese, obese 9 months after JIB and obese 20 years after JIB) of six females each were given a mixed meal (280 kcal). Plasma samples were obtained every 10 min for 60 min postprandially and were analyzed for glucose, insulin, GIP and GLP-1. A reduction in body mass index (kg/m2) was seen for the two patient groups operated with JIB (12.1, at 9 months post-op; 13.1, at 20 years post-op). Surgery by JIB resulted in a reduction of glucose and insulin values. Concomitantly there was an elevation of postprandial GIP and GLP-1 plasma concentrations. In the obese subjects 20 years after JIB both fasting and postprandial GIP and GLP-1 values were markedly elevated compared with the other three groups; and plasma glucose and insulin concentrations were maintained at normal levels. The improvement in glucose metabolism seen after JIB may be due to reduced insulin resistance after weight loss and/or increased levels of the incretin hormones GIP and GLP-1. Progressively, elevated levels of GIP and GLP-1 seem to be necessary to maintain glucose homeostasis at long-term follow-up after this procedure.

Home Total Parenteral Nutrition in a Pregnant Diabetic after Jejunoileal Bypass for Obesity

Pregnancy after jejunoileal bypass (JIBP) for obesity is generally well tolerated without serious complications. A 24-yr-old diabetic patient who had previously had a JIBP procedure presented during pregnancy with severe malnutrition. She was treated successfully with home total parenteral nutrition. Previously published experience with pregnancy after JIBP and the use of parenteral nutrition during pregnancy is reviewed.

A selection of photographs from the 1987 A/S/G/E Learning Center

1. A 55-year-old male with chronic renal failure had a long history of peptic ulcer disease. Which of the following are true about this unusual pyloric deformity seen at endoscopy? a. More often acquired rather than congenital. b. This is an antral-duodenal fistula. c. Usually requires surgery. d. May contain an ulcer. 2. This 19-year-old bone marrow transplant patient developed odynophagia. At endoscopy extensive ulceration and inflammation were noted. Which of the following are true about this condition? a. This is classic candida esophagitis. b. This condition may occur in all immunosuppressed patients including those with AIDS. c. Endoscopically this is indistinguishable from herpetic esophagitis. d. The causative agent in this condition can frequently be found in other areas of the gastrointestinal tract. 3. A 38-year-old female was endoscoped because of intermittent dysphagia to large pills. This semilunar projection was noted at 20 em from the incisor teeth. Which of the following are true? a. Associated with the Plummer-Vinson syndrome. b. This finding is most compatible with a Schatzki ring. c. May be multiple. d. Initial diagnosis probably best with radiography. 4. A 17-year-old high school football player had an FUO followed in 3 weeks by dysphagia and odynophagia. A barium swallow demonstrated extrinsic compression of the midesophagus, probably by subcarinallymph nodes. Biopsy taken through the small sinus tracts seen at endoscopy revealed granulomatous necrotizing lymphadenitis. This unusual condition is compatible with: a. Crohn's esophagitis b. Occult malignancy c. Cat scratch fever d. Mediastinal lymphoma 5. This laparoscopic view of the liver was seen in a 22-year-old female with abdominal pain, vomiting, and early satiety. Upper gastrointestinal series showed a mass pressing on the stomach. Which of the following are true regarding the lesion seen? a. Usually associated with the use of oral contraceptives. b. May present with intraabdominal hemonhage and shock. c. Should be resected. d. Biopsy is risky. 6. This patient developed deteriorating liver function tests and ascites 10 years following a jejunoileal bypass for obesity. Laparoscopy revealed this appearance of the liver. Expected histology would be: a. Hepatoma b. Adenocarcinoma c. Steatocinhosis d. Multiple adenomas

Episodic arthritis, skin manifestations and immune complexes following intestinal by-pass operations for morbid obesity.

A systematic search for immune complexes (IC) in blood and skin revealed no correlation to IC-related disorders in 35 patients who had undergone jejunoileal bypass for obesity. Tests for cryoprecipitates and endotoxins proved negative.

Jejunoileal Bypass for Obesity: A Risk Factor tor Tuberculosis

Jejunoileal Bypass for Obesity: A Risk Factor tor Tuberculosis

Treatment of bone disease after jejunoileal bypass for obesity with oral 1 alpha-hydroxyvitamin D3.

The effects of oral 1 alpha-hydroxyvitamin D3 have been investigated in 12 patients with bone disease after jejunoileal bypass for obesity. Bone histology became normal or improved greatly after four to 12 months' treatment in eight patients but showed little change or worsened in four. There was a significant rise in plasma calcium and fall in plasma alkaline phosphatase concentration with 1 alpha-hydroxyvitamin D3 therapy in the patients with a good histological response. Administration of metronidazole and cotrimoxazole to two patients who had failed to respond to 1 alpha-hydroxyvitamin D3 resulted in clinical and biochemical improvement; in one of these patients histological improvement was also documented. It is concluded that oral 1 alpha-hydroxyvitamin D3 can be effective in healing post-bypass bone disease; the failure of some patients to respond may be related to bacterial contamination of the small intestine and in those patients antibiotics may also be indicated.

Low serum levels of 1.25-dihydroxyvitamin D and histomorphometric evidence of osteomalacia after jejunoileal bypass for obesity.

Twenty-seven unselected patients were investigated three to eight years after jejunoileal bypass for morbid obesity. The serum levels of calcium, magnesium, and phosphorus, and the renal excretions of calcium and magnesium were reduced. The serum alkaline phosphatase levels were increased. The serum levels of the two vitamin D metabolites 25-hydroxyvitamin D (25-OHD) and 1.25-dihydroxyvitamin D (1.25-(OHD)2D) were reduced and inversely related to the increased serum levels of immunoreactive parathyroid hormones (iPTH). Serum 1.25-(OH)2D correlated positively and serum iPTH inversely with serum concentrations and renal excretion rates of calcium. Iliac crest bone biopsies after in vivo tetracycline double-labelling showed a reduced bone turnover with an increased amount of osteoid due to an increase in both surface extent and mean width of osteoid seams. The increased volume of osteoid was caused by a decreased osteoblastic function with a longer life-span of bone-forming sites and a prolongation of the mineralisation lag time. The amount of trabecular bone was normal. The results indicate an impaired vitamin D metabolism with osteomalacia and secondary hyperparathyroidism.

Jejunoileal bypass for obesity—what can we learn from a literature study?

A computerized search was made of all publications on jejunoileal bypass for obesity, recorded in Index Medicus during 1963 to 1977. A total of 171 references, dealing with 6319 patients were usable for the purpose. Fifty-three variables were registered. The great majority of publications is American and published since 1972. Only 20% are joint publications from collaborating surgical and medical departments. The study draws attention to a number of quantitative and qualitative deficiencies in the data and to the less expedient way they are sometimes presented. Principally, this applies to patient number and description, length of observation time, and frequency of complications. Lack of specified criteria for surgical eligibility is common, as is ambiguity in conclusion. It is suggested that recommendations, positive or negative, reflect the authors' subjective attitude, as they are apparently made from the same objective data.

Dynamic differences in trabecular bone remodeling between patients after Jejuno-ileal bypass for obesity and epileptic patients receiving anticonvulsant therapy

A histomorphometric evaluation of iliac crest trabecular bone remodeling was performed after tetracycline double-labeling in 27 patients 3 to 8 years after intestinal bypass for severe obesity, in 20 epileptic patients with bone changes induced by anticonvulsants and in two six- and age- matched normal groups. The amount of trabecular bone was normal and the amount of osteoid was increased in both patient groups. In the epileptic patients the bone formation rate was normal at active cellular level and at BMU level, but increased at tissue level indicating a high turnover state. The appositional rate and the mineralization lag time was normal. The extent of bone formation and bone resorption surfaces was increased because of the increased turnover. In the intestinal shunt patients the bone formation rate was decreased at active cellular level, BMU level and tissue level. The appositional rate of osteoid was decreased and the mineralization lag time markedly prolonged. The extent of bone formation and bone resorption surfaces was increased because of a prolonged bone formation and bone resorption period. These demonstrated dynamic differences in trabecular bone remodeling suggest either a different pathogenesis for the two disease processes or that different stages in the disease processes are being observed.

Malabsorption of Thyroid Hormones After Jejunoileal Bypass for Obesity

Brief Reports1 June 1979Malabsorption of Thyroid Hormones After Jejunoileal Bypass for ObesityFEREIDOUN AZIZI, M.D., ROY BELUR, M.S., JOSEPHINE ALBANO, M.D.FEREIDOUN AZIZI, M.D.Search for more papers by this author, ROY BELUR, M.S.Search for more papers by this author, JOSEPHINE ALBANO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-6-941 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe malabsorption state caused by small intestinal bypass surgery may result in nutritional deficiencies. The drastic loss of jejunum and ileum interferes with normal absorption of various substances, leading to metabolic derangement, vitamin deficiencies, and even nutritional cirrhosis of the liver (1). We have recently seen a patient with hypothyroidism and obesity who developed severe malabsorption of thyroid hormones after a bypass operation.A 38-year-old white woman was referred for evaluation of hypothyroidism in March 1977. She had been grossly obese ( >160 kg) for most of her adult life and had undergone a small intestinal bypass in August 1974....

Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity

Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.

Metabolic changes after jejuno-ileal bypass for obesity.

Metabolic parameters were studied in 6 patients before and for 18 months after jejunoileal bypass for obesity. The postoperative changes in plasma concentration of amino acids were characterized by a decrease in essential amino acids, while the non-essential amino acids were unchanged or elevated, indicating a state of protein-caloric malnutrition. The pattern of fatty acids in serum the first year after operation: an unchanged sum of unsaturated and saturated fatty acids accompanied by a significant fall in linoleic acid and a corresponding increase in oleic acid, showed that even during this period the patients were in a state of essential fatty acid deficiency. The oral glucose tolerance test and the levels of serum immunoreactive insulin activity indicated a general improvement in glucose tolerance and a normalization of preoperative hyperinsulinism. A 40-50% reduction was found both in serum triglycerides and cholesterol levels. Serum iron was reduced by approximately 30%, whereas TIBC levels remained unchanged. The Schilling test showed a significant fall in vitamin B12 absorption postoperatively with subnormal values at 6 and 12 months. Vitamin B12 in serum dropped, but remained within the normal range, suggesting that the preservation of 25 cm of distal ileum is sufficient to secure adequate absorption of vitamin B12. Folic acid levels in serum fell after the bypass, demanding supplementation in 5 of the 6 patients at 6 months postoperatively.

Role of caloric intake in the weight loss after jejunoileal bypass for obesity

Sixty-five patients were studied prospectively after jejunoileal bypass for obesity. Dietary intake pre- and postoperatively was measured either directly by weighing food or by a research dietary history. Of 65 measurements, 59 were made at least 6 months after operation, when over 75% of weight loss had been achieved. Fat absorption was measured in 42 of the patients. The entire group ate fewer calories (mean ± se = 2595 ± 135) postoperatively than preoperatively (mean ± se = 3261 ± 138). This difference was highly significant (P < 0.001). Forty-eight patients ate less after their operation. The caloric deficit calculated from the observed weight loss could be accounted for entirely by the estimated decrease in intake in 22 of the 48 patients who ate less postoperatively. Moreover, measured fat malabsorption accounted for only 31% of the observed weight loss in those who ate more postoperatively and 21% in those who ate less. We conclude that a decrease in caloric intake, along with malabsorption, is an important factor in the long term postoperative weight loss (1–9 months) after jejunoileal bypass for obesity.

Pregnancy following jejunoileal bypass for obesity

With the ascending branch of the uterine artery used as an example, the pedicle is clamped in the usual fashion and a ligature is placed (Fig. 1, I). The clamp is then removed and the suture is tied in the groove created by the jaws of the clamp (2). Next the pedicle is reclamped just above the tie (3). Finally, the pedicle is cur f rer bur is still secured if a second suture is needed (J). The atl\‘antages of this technique are: (1) that the uncut vessels are secured without the possibility that a suture will break or the cut end of an artery will be lost front the clamp. (2) that compacted tissue is more easily ligated, and (3) that a minimal number of surgical in51ruments are required when space is at a premium.

Pneumatosis intestinalis as a complication of jejunoileal bypass

Four patients with pneumatosis intestinalis involving the unbypassed functioning bowel after jejunoileal bypass for obesity are reported. Previous publications of pneumatosis intestinalis after jejunoileal bypass discussed involvement only of the bypassed defunctionalized bowel. Symptomatology can range from mild to severe. The treatment of pneumatosis intestinalis is conservative. The specific etiology of the pneumatosis in this group of patients is not known.

A community-wide experience with jejunoileal bypass for obesity

The records of seventy-nine patients who had jejunoileal bypass operations for morbid obesity were reviewed. The data represent the entire experience of surgeons in the Louisville, Kentucky metropolitan area for the period studied. Retrospective evaluations of criteria for selecting patients for bypass operation, type of shunt done, and clinical results were recorded. Sixty-eight patients (86 per cent) weighed more than 100 pounds over ideal weight. Operative mortality was 5 per cent. Only 31 patients (47 per cent) were judged as having satisfactory results. Two patients died of hepatic failure and five required restoration of intestinal continuity. Comparison of this community experience with published data supports the concept that these operations are best confined to those institutions where there is special interest in the full range of medical and surgical care of obese patients.

Gastrointestinal Adaptation Following Small Bowel Bypass for Obesity

Small intestinal morphologic and biochemical changes were studied following jejuno-ileal bypass for obesity after body weight stabilization had occurred. Four patients underwent biopsy of in-continuity and bypassed jejunal and ileal segments of the small intestine 11 to 22 months after the bypass operation. Microscopically, marked mucosal villus hypertrophy of the in-continuity bowel was observed, especially in the ileum. Bypassed jejunal mucosa underwent atrophy compared with pre-bypass jejunum, whereas bypassed ileum appeared similar microscopically to pre-bypass ileum. The specific activities of mucosal disaccharidase enzymes (maltase, sucrase, lactase and trehalase) in units per mg protein remained similar to pre-bypass levels in segments of the in-continuity jejunum and the bypassed jejunum and ileum. On the other hand, elevated mucosal disaccharidase levels were measured in biopsy specimens of the in-continuity ileum. Total enzyme activity per unit length of intestine, however, was estimated to be elevated in both in-continuity jejunum and ileum secondary to mucosal villus hypertrophy. These data indicate that following small bowel bypass: (1) the in-continuity ileum undergoes greater biochemical and morphologic adaptation than the jejunum; and (2) intraluminal nutrients and chyme appear to be essential to maximal intestinal adaptation.

Certain metabolic consequences of jejunoileal bypass

Jejunoileal bypass for obesity has been shown to be associated with increased hepatic triglycerides during the period of brisk weight loss. The current report describes certain metabolic changes observed in 29 patients 21 months after bypass. Significant decreases in serum cholesterol, serum triglycerides, blood sugar after a glucose load, and fasting plasma insulin levels were noted. Increased oxalate excretion and occasional episodes of hypomagnesemia occurred. Repeated clinical and laboratory observations by a medical-surgical team offer the best opportunity to evaluate this procedure.

Clinical nutrition; current status of jejunoileal bypass for obesity

Clinical nutrition; current status of jejunoileal bypass for obesity