The effect of Roux-en-Y gastric bypass in the treatment of hypertension and diabetes.

INTRODUCTION: obesity has become a public health problem in Brazil and worldwide, due to its high prevalence. It is considered a risk factor for systemic arterial hypertension (SAH) and type 2 diabetes mellitus T2DM. Although lifestyle changes can control and even achieve complete T2DM remission, most patients have difficulty controlling blood glucose. Recent studies show that the Roux-en-Y gastric bypass (RYGB) is efficient for weight loss and control of T2DM and SAH in obese individuals. OBJECTIVE: to analyze the effect of the RYGB technique on the control and treatment of comorbidities related to obesity. METHOD: this is a retrospective cohort study, with information obtained from the review of medical records, with data collection in the pre and postoperative period of patients undergoing bariatric surgery. We selected those with T2DM and SAH for the study. RESULTS: 252 patients underwent RYGB in the service. Seventy-nine (31.3%) had T2DM and 64 had SAH associated with T2DM. Regarding T2DM and SAH, 37.9% and 43,7%, respectively, showed total remission of the disease after surgery. There was a reduction in the postoperative use of Metformin, insulin / Gliclazide, Propranolol, Losartan and Hydrochlorothiazide in 62%, 10.1%, 100%, 26.5% and 22.8% of patients, respectively. CONCLUSION: the RYGB technique is effective in the remission of T2DM and SAH. Even in cases where there was no total remission of the diseases, there was a significant drop in the use of medicines used for their treatment.

The effect of Roux-en-Y gastric bypass in the treatment of hypertension and diabetes / O efeito da derivação gástrica em Y de Roux no tratamento da hipertensão e do diabetes

ABSTRACT Introduction: obesity has become a public health problem in Brazil and worldwide, due to its high prevalence. It is considered a risk factor for systemic arterial hypertension (SAH) and type 2 diabetes mellitus T2DM. Although lifestyle changes can control and even achieve complete T2DM remission, most patients have difficulty controlling blood glucose. Recent studies show that the Roux-en-Y gastric bypass (RYGB) is efficient for weight loss and control of T2DM and SAH in obese individuals. Objective: to analyze the effect of the RYGB technique on the control and treatment of comorbidities related to obesity. Method: this is a retrospective cohort study, with information obtained from the review of medical records, with data collection in the pre and postoperative period of patients undergoing bariatric surgery. We selected those with T2DM and SAH for the study. Results: 252 patients underwent RYGB in the service. Seventy-nine (31.3%) had T2DM and 64 had SAH associated with T2DM. Regarding T2DM and SAH, 37.9% and 43,7%, respectively, showed total remission of the disease after surgery. There was a reduction in the postoperative use of Metformin, insulin / Gliclazide, Propranolol, Losartan and Hydrochlorothiazide in 62%, 10.1%, 100%, 26.5% and 22.8% of patients, respectively. Conclusion: the RYGB technique is effective in the remission of T2DM and SAH. Even in cases where there was no total remission of the diseases, there was a significant drop in the use of medicines used for their treatment.

RESUMO Introdução: a obesidade tornou-se problema de saúde pública no Brasil e no mundo, devido à alta prevalência. É considerada fator de risco para doenças metabólicas, como hipertensão arterial sistêmica (HAS) e diabetes Mellitus tipo 2 (DM2). Embora a modificação do estilo de vida possa controlar e até levar à remissão total do DM2, a maioria dos pacientes tem dificuldade em controlar a glicemia. Estudos recentes mostram que a derivação gástrica em Y de Roux (RYGB) é eficiente para a perda de peso e o controle de comorbidades em pacientes obesos. Objetivo: analisar o efeito da técnica RYGB no controle e tratamento de comorbidades relacionadas à obesidade. Método: trata-se de estudo de coorte retrospectivo, com informações obtidas pela revisão de prontuários, com coleta de dados no pré e pós-operatório de pacientes submetidos a cirurgia bariátrica. Selecionamos para o estudo aqueles com DM2 e HAS. Resultados: 252 pacientes foram submetidos à RYGB no serviço. Setenta e nove (31,3%) tinham DM2 e 64 tinham HAS associada a DM2. Com relação ao DM2 e à HAS, 37,9% e 43,7%, respectivamente, apresentaram remissão total da doença após a operação. Houve redução no pós-operatório do uso de Metformina, insulina/Gliclazida, Propranolol, Losartana e Hidroclorotiazida em 62%, 10,1%, 100%, 26,5% e 22,8% dos pacientes, respectivamente. Conclusão: a técnica da RYGB é efetiva na remissão do DM2 e HAS. Mesmo nos casos em que não houve a remissão total das doenças, houve queda significativa no uso de medicamentos usados para o tratamento.

Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery

Background The objective of this study was to assess the impact of bariatric surgery performed in extremely obesenon-diabetic subjects on the following parameters: endothelial function, inflammatory processes (assessed by highsensitivity C-reactive protein [hs-CRP]), carotid arteryintima-media thickness (CIMT), and glucose and lipid profiles. Methods Forty-seven obese individuals with body mass index >40 kg/m2 underwent bariatric surgery and returned for post-procedure assessment between 6 and 19 months after surgery. Ninety-three percent of patients were female.Their age ranged from 18 to 65 (mean 41) years old at baseline. Baseline was defined as the maximum of 30 days before surgery. Before and after surgery, all patients were subjected to a brachial artery ultrasound examination to evaluate endothelial-dependent dilation, CIMT by ultrasound, and laboratory analyses including glucose, lipidand inflammatory profiles were performed. Results Subjects lost an average of 33 % of their original weight (p<0.001). Flow-mediated dilation showed significant improvement after surgery from 7.4 % to 18.9 % (p<0.001)on average. There was regression of CIMT, with the median being reduced from 0.8 to 0.5mm(p<0.001). The median Hs-CRP reduced from 0.83 to 0.18 mg/dl (p<0.001), while glucose and lipid profiles were also improved after surgery. Conclusions This study shows that severely obese, non diabetic patients who had pronounced weight loss after bariatric surgery had an overall improvement in brachial flow-mediated dilation, CIMT, high-sensitivity CRP, and glucose and lipid metabolism. The best responses of the brachial flow-mediated dilation after surgery were observed in non-smokers and in younger subjects.