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2.
Surg Endosc ; 34(12): 5368-5376, 2020 12.
Article in English | MEDLINE | ID: mdl-31993812

ABSTRACT

BACKGROUND: Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. METHODS: We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. RESULTS: A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. CONCLUSION: We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL.


Subject(s)
Gastric Bypass/adverse effects , Gastric Bypass/methods , Quality of Life/psychology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Risk Factors , Time Factors
3.
BJS Open ; 3(3): 317-326, 2019 06.
Article in English | MEDLINE | ID: mdl-31183448

ABSTRACT

Background: Despite increased emphasis on patient-reported outcomes, few studies have focused on abdominal pain symptoms before and after Roux-en-Y gastric bypass (RYGB). The aim of this study was to quantify chronic abdominal pain (CAP) in relation to RYGB. Methods: Patients with morbid obesity planned for RYGB were invited to participate at a tertiary referral centre from February 2014 to June 2015. Participants completed a series of seven questionnaires before and 2 years after RYGB. CAP was defined as patient-reported presence of long-term or recurrent abdominal pain lasting for more than 3 months. Results: A total of 236 patients were included, of whom 209 (88·6 per cent) attended follow-up. CAP was reported by 28 patients (11·9 per cent) at baseline and 60 (28·7 per cent) at follow-up (P < 0·001). Gastrointestinal Symptom Rating Scale (GSRS) scores (except reflux scores) and symptoms of anxiety increased from baseline to follow-up. Most quality of life (QoL) scores (except role emotional, mental health and mental component scores) also increased. At follow-up, patients with CAP had higher GSRS scores than those without CAP, with large effect sizes for abdominal pain and indigestion syndrome scores. Patients with CAP had more symptoms of anxiety, higher levels of catastrophizing and lower QoL scores. Baseline CAP seemed to predict CAP at follow-up. Conclusion: The prevalence of CAP is higher 2 years after RYGB compared with baseline values.


Subject(s)
Abdominal Pain/epidemiology , Abdominal Pain/etiology , Gastric Bypass/adverse effects , Obesity, Morbid/surgery , Abdominal Pain/psychology , Adult , Aftercare/statistics & numerical data , Anxiety Disorders/epidemiology , Chronic Disease , Female , Gastric Bypass/methods , Gastric Bypass/trends , Gastrointestinal Diseases/epidemiology , Humans , Male , Middle Aged , Norway/epidemiology , Patient Reported Outcome Measures , Postoperative Complications/epidemiology , Prevalence , Prospective Studies , Quality of Life , Surveys and Questionnaires , Tertiary Care Centers
4.
Sci Rep ; 9(1): 167, 2019 01 17.
Article in English | MEDLINE | ID: mdl-30655568

ABSTRACT

Common variable immunodeficiency (CVID) patients have reduced gut microbial diversity compared to healthy controls. The reduced diversity is associated with gut leakage, increased systemic inflammation and ten "key" bacteria that capture the gut dysbiosis (dysbiosis index) in CVID. Rifaximin is a broad-spectrum non-absorbable antibiotic known to reduce gut leakage (lipopolysaccharides, LPS) in liver disease. In this study, we explored as a 'proof of concept' that altering gut microbial composition could reduce systemic inflammation, using CVID as a disease model. Forty adult CVID patients were randomized, (1:1) to twice-daily oral rifaximin 550 mg versus no treatment for 2 weeks in an open-label, single-centre study. Primary endpoints were reduction in plasma/serum levels of soluble (s) CD14, sCD25, sCD163, neopterin, CRP, TNF, LPS and selected cytokines measured at 0, 2 and 8 weeks. Secondary endpoint was changes in intra-individual bacterial diversity in stool samples. Rifaximin-use did not significantly change any of the inflammation or gut leakage markers, but decreased gut microbial diversity compared with no treatment (p = 0.002). Importantly, the gut bacteria in the CVID dysbiosis index were not changed by rifaximin. The results suggest that modulating gut microbiota by rifaximin is not the chosen intervention to affect systemic inflammation, at least not in CVID.


Subject(s)
Biomarkers/analysis , Common Variable Immunodeficiency/drug therapy , Dysbiosis/drug therapy , Gastrointestinal Microbiome/drug effects , Inflammation/drug therapy , Rifaximin/therapeutic use , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Female , Gastrointestinal Agents/therapeutic use , Humans , Male , Middle Aged , Proof of Concept Study , Prospective Studies , Young Adult
5.
Mucosal Immunol ; 9(6): 1455-1465, 2016 11.
Article in English | MEDLINE | ID: mdl-26982597

ABSTRACT

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency characterized by low immunoglobulin (Ig)G and IgA, and/or IgM. In addition to bacterial infections, a large subgroup has noninfectious inflammatory and autoimmune complications. We performed 16S ribosomal RNA-based profiling of stool samples in 44 CVID patients, 45 patients with inflammatory bowel disease (disease controls), and 263 healthy controls. We measured plasma lipopolysaccharide (LPS) and markers of immune cell activation (i.e., soluble (s) CD14 and sCD25) in an expanded cohort of 104 patients with CVID and in 30 healthy controls. We found a large shift in the microbiota of CVID patients characterized by a reduced within-individual bacterial diversity (alpha diversity, P<0.001) without obvious associations to antibiotics use. Plasma levels of both LPS (P=0.001) and sCD25 (P<0.0001) were elevated in CVID, correlating negatively with alpha diversity and positively with a dysbiosis index calculated from the taxonomic profile. Low alpha diversity and high dysbiosis index, LPS, and immune markers were most pronounced in the subgroup with inflammatory and autoimmune complications. Low level of IgA was associated with decreased alpha diversity, but not independently from sCD25 and LPS. Our findings suggest a link between immunodeficiency, systemic immune activation, LPS, and altered gut microbiota.


Subject(s)
Common Variable Immunodeficiency/immunology , Common Variable Immunodeficiency/microbiology , Dysbiosis/immunology , Gastrointestinal Microbiome/immunology , Lipopolysaccharides/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Biodiversity , Biomarkers , Case-Control Studies , Female , Humans , Immunoglobulin A/immunology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/microbiology , Interleukin-2 Receptor alpha Subunit/metabolism , Lymphocyte Activation/immunology , Male , Middle Aged , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Young Adult
6.
Acta Pharmacol Toxicol (Copenh) ; 42(3): 212-8, 1978 Mar.
Article in English | MEDLINE | ID: mdl-580348

ABSTRACT

The pharmacokinetics of adriamycin given as free and in DNA-complexed form was compared in six children with malignant disease. The two types of adriamycin were given to the same child at 3--4-week intervals, thereby excluding genetic variations when comparing the results. Plasma and urine were collected during and after the drug infusion, and the drug concentrations were measured by means of a sensitive fluorimetric procedure. The study shows that one obtains: 1. a much higher plasma concentration of adriamycin when it is given in the complexed form. 2. a lower urine excretion of adriamycin and fluorescent metabolites when adriamycin is administered as the DNA-complex.


Subject(s)
DNA/metabolism , Doxorubicin/metabolism , Neoplasms/drug therapy , Child , Doxorubicin/administration & dosage , Doxorubicin/therapeutic use , Drug Evaluation , Fluorescence , Humans
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