-
Rodolphe Anty,
Sophie Marjoux,
Antonio Iannelli,
Stéphanie Patouraux,
Anne-Sophie Schneck,
Stéphanie Bonnafous,
Camille Gire,
Anca Amzolini, Imed Ben-Amor,
Marie-Christine Saint-Paul,
Eugenia Mariné-Barjoan,
Alexandre Pariente,
Jean Gugenheim,
Philippe Gual,
Albert Tran
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to determine the influence of coffee and other caffeinated drinks on liver fibrosis of severely obese European patients.
A specific questionnaire exploring various types of coffee (regular filtrated coffee and espresso), caffeinated drinks, and chocolate was filled in by 195 severely obese patients. All patients had liver biopsies that were analyzed according to the NASH Clinical Research Network Scoring System. Univariate and multivariate analyses of significant fibrosis were performed.
Caffeine came mainly from coffee-containing beverages (77.5%). Regular coffee and espresso were consumed in 30.8% and 50.2% of the patients, respectively. Regular coffee, espresso, and total caffeine consumption was similar between patients with and without NASH. While consumption of espresso, caffeinated soft drinks, and chocolate was similar among patients, with respect to the level of fibrosis, regular coffee consumption was lower in patients with significant fibrosis (F ⩾2). According to logistic regression analysis, consumption of regular coffee was an independent protective factor for fibrosis (OR: 0.752 [0.578-0.980], p=0.035) in a model including level of AST (OR: 1.04 [1.004-1.076], p=0.029), presence of NASH (OR: 2.41 [1.007-5.782], p=0.048), presence of the metabolic syndrome (NS), and level of HOMA-IR (NS). Espresso, but not regular coffee consumption was higher in patients with lower HDL cholesterol level, higher triglyceride level, and the metabolic syndrome.
Consumption of regular coffee but not espresso is an independent protective factor for liver fibrosis in severely obese European patients.
Journal of Hepatology 07/2012; 57(5):1090-6. · 9.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic sleeve gastrectomy (LSG) has been rapidly accepted as a valuable bariatric procedure before its effectiveness on weight loss in the long-term is clearly demonstrated. We report a feasibility study including 13 patients undergoing a redo LSG for either progressive weight regain after initial weight loss of insufficient weight loss.
From October 2005 to April 2010, 13 patients underwent a re-sleeve gastrectomy procedure for progressive weight regain or insufficient weight loss (<50% of excess weight (EW)) associated with the persistence of the gastric fundus on upper gastrointestinal series.
Mean initial body mass index (BMI) and EW were 44.6 (37-52.9) kg/m(2) and 61.8 (38.2-93.9) kg, respectively. There were ten comorbid conditions in five out of the 13 patients. The revision resulted in a mean BMI, percent of excess weight loss (%EWL), and percentage of excess BMI loss (%EBL) of 32.3 kg/m(2), 50.3%, and 57% at 1 month; 32 kg/m(2), 47.9%, and 54.5 at 6 months; and 27.5 kg/m(2), 71.4%, and 82.8% at 12 months, respectively. There was no morbidity.
Laparoscopic revision of LSG is safe and effective in the short term to obtain substantial loss of weight and improvement in comorbidities.
Obesity Surgery 10/2010; 21(7):832-5. · 3.29 Impact Factor
-
Rodolphe Anty,
Monsef Dahman,
Antonio Iannelli,
Philippe Gual,
Aline Staccini-Myx, Imed Ben Amor,
Nathalie Luciani,
Marie-Christine Saint-Paul,
Pierre-Michel Huet,
Jean-Louis Sadoul,
Surjit Kaila S Srai,
Robert Unwin,
Jean Gugenheim,
Yannick Le Marchand-Brustel,
Albert Tran,
Soumeya Bekri
[show abstract]
[hide abstract]
ABSTRACT: Obesity is associated with a chronic and low-grade inflammation which may cause hypoferremia as seen in patients with chronic inflammatory diseases. The aim of the present study was to investigate the relationship between iron status and markers of inflammation in morbidly obese women and the effect of bariatric surgery.
Our cohort of patients consisted of 178 morbidly obese females selected for bariatric surgery. Clinical and biochemical data were recorded before surgery, and histopathological studies were carried out on preoperative liver biopsy samples. Fifty-five patients have been followed up after bariatric surgery.
A high prevalence of iron depletion was present in this cohort, with 53% having a transferrin saturation ratio below 0.20. Iron depletion was significantly correlated with raised levels of indices of inflammation, C-reactive protein (CRP), orosomucoid and haptoglobin), and with the white blood cell count. In multivariate analysis, orosomucoid and CRP were independently associated with iron depletion. Moreover, 6 months after bariatric surgery, inflammation level decreased, which was inversely correlated with the increase in transferrin saturation.
Iron depletion is common in morbidly obese women. Low-grade chronic inflammation associated with obesity could be a modulator of iron uptake and utilization. Bariatric surgery may reduce chronic inflammation and improve iron status.
Obesity Surgery 07/2008; 18(6):709-14. · 3.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Revision of bariatric procedures is required in 10 to 25% of patients either for insufficient weight loss or for complications. Patients undergoing vertical banded gastroplasty (VBG; Mason MacLean) may require revision in up to half of the cases in the long term. Roux-en-Y gastric bypass (RYGBP) is considered the procedure of choice for revision of VBG gastroplasty.
Eighteen patients, 16 women and 2 men with a mean age of 41.7 years (range 27-72) and a mean BMI at 37.6 kg/m(2) (range 22.5-47), underwent laparoscopic conversion of VBG into RYGBP. Indications for revisional surgery were insufficient weight loss (11 patients), stoma stenosis (4 patients), and acid reflux (3 patients).
Operative time was on average 203 min (range 60-300 min), and conversion was required in one patient (5.5%). There was no early postoperative mortality, and four patients (22.2%) developed immediate postoperative complications (gastrojejunostomy leak 1; stenosis of the gastrojejunal anastomosis 2; liver abscess 1). One patient died 6 months after conversion because of a bleeding anastomotic ulcer (late mortality 5.5%). Two patients (11.5%) developed late complications (incisional hernia 1; internal hernia 1). At a mean follow-up of 23, 4 months BMI is on average 29.8 kg/m(2) (range 22.7-37).
Although revision of failed VBG into RYGBP gives good functional results, the risk of postoperative serious complications must be carefully evaluated before revision.
Obesity Surgery 02/2008; 18(1):43-6. · 3.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Internal hernia (IH) is a well known complication of Roux-en-Y gastric bypass (RYGBP) which is more frequently encountered when the RYGBP is done laparoscopically.
Patients with IH were identified from a prospective data-base of morbidly obese patients undergoing bariatric surgery at our center.
10 patients with IH were identified out of 625 patients undergoing LRYGBP from 1998 to 2006 (incidence 1.6 %). The defects were closed in the last 155 cases with non-absorbable running sutures. There were 8 women and 2 men with mean age 38 years (range 28-54). The mean interval of time elapsed between LRYGBP and clinical presentation of IH was 26.5 months (range 7 days - 72 months). Abdominal pain, nausea and vomiting were the most common complaints. White blood cell count was increased to a mean of 64 mg/dl (range 45-155 mg/dl) in 6 patients. CT scan showed signs of intestinal obstruction in all 7 patients with acute presentation. Surgery was done by laparoscopy in 5 cases (2 in the setting of emergency), and by laparotomy in the remaining 5 cases. All IHs were located at the mesenteric defect and were treated with IH reduction in all but one patient who underwent small bowel resection. There was no mortality, and one patient had pneumonia with acute respiratory distress syndrome that resolved favorably.
IH after LRYGBP occurred mainly at the mesenteric defect and in patients with no closure of the defect. The antecolic approach for the Roux-limb, the division of the greater omentum only when too thick, and the systematic closure of the defects with tight non-absorbable running sutures are recommended.
Obesity Surgery 11/2007; 17(10):1283-6. · 3.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vertical banded gastroplasty (VBG) is associated with a significant rate of revision because of regain of weight due to staple-line disruption, gastric pouch and stoma dilation, change to sweet eating, outlet stenosis with vomiting and reflux. To avoid reflux, some surgeons added an antireflux wrap.
We report laparoscopic revision of VBG with antireflux wrap to Roux-en-Y gastric bypass (RYGBP) in 4 patients. The indication for revision was insufficient weight loss in all 4 patients, with stenosis of the stoma resistant to endoscopic balloon dilation in one and reflux esophagitis in one, who shifted to high-calorie liquids. Revision was performed 73.5 months (range 57-84) after the primary procedure, at mean BMI 39.5 (range 37-41).
Mean operative time was 193.7 min (165-220). There was no conversion to open surgery. There was no mortality. One patient developed a stenosis at the gastrojejunostomy that was managed successfully with endoscopic balloon dilation. Mean length of stay was 6.8 days (range 4-9). At mean follow-up of 11.2 months (range 11-18), mean BMI is 28.5 (range 27-30), and all patients were free of co-morbidities.
Laparoscopic revision of VBG with an antireflux wrap into an LRYGBP is feasible and effective in achieving weight loss, but the safety requires assessment by a larger series.
Obesity Surgery 08/2007; 17(7):901-4. · 3.29 Impact Factor
-
Soumeya Bekri,
Philippe Gual,
Rodolphe Anty,
Nathalie Luciani,
Monsef Dahman,
Bala Ramesh,
Antonio Iannelli,
Aline Staccini-Myx,
Dominique Casanova, Imed Ben Amor,
Marie-Christine Saint-Paul,
Pierre-Michel Huet,
Jean-Louis Sadoul,
Jean Gugenheim,
Surjit Kaila S Srai,
Albert Tran,
Yannick Le Marchand-Brustel
[show abstract]
[hide abstract]
ABSTRACT: Hepcidin is an acute-phase response peptide. We have investigated the possible involvement of hepcidin in massive obesity, a state of chronic low-grade inflammation. Three groups of severely obese patients with or without diabetes or nonalcoholic steatohepatitis were investigated.
Hepcidin expression was studied in liver and adipose tissue of these patients. Hepcidin regulation was investigated in vitro by adipose tissue explant stimulation studies.
Hepcidin was expressed not only in the liver but also at the messenger RNA (mRNA) and the protein levels in adipose tissue. Moreover, mRNA expression was increased in adipose tissue of obese patients. The presence of diabetes or NASH did not modify the hepcidin expression levels in liver and adipose tissue. In adipose tissue, mRNA expression correlated with indexes of inflammation, interleukin-6, and C-reactive protein. Interleukin-6 also promoted in vitro hepcidin expression. A low transferrin saturation ratio was observed in 68% of the obese patients; moreover, 24% of these patients presented with anemia. The observed changes in iron status could be due to the role of hepcidin as a negative regulator of intestinal iron absorption and macrophage iron efflux. Interestingly, a feedback control mechanism on hepcidin expression related to low transferrin saturation occurred in the liver but not in the adipose tissue.
Hepcidin is a proinflammatory adipokine and may play an important role in hypoferremia of inflammation in obese condition.
Gastroenterology 09/2006; 131(3):788-96. · 11.68 Impact Factor
-
Rodolphe Anty,
Soumeya Bekri,
Nathalie Luciani,
Marie-Christine Saint-Paul,
Moncef Dahman,
Antonio Iannelli, Imed Ben Amor,
Aline Staccini-Myx,
Pierre-Michel Huet,
Jean Gugenheim,
Jean-Louis Sadoul,
Yannick Le Marchand-Brustel,
Albert Tran,
Philippe Gual
[show abstract]
[hide abstract]
ABSTRACT: C-Reactive Protein (CRP), a nonspecific marker of inflammation that is moderately elevated in obesity, metabolic syndrome (MS), and type 2 diabetes, has been proposed as a surrogate marker of nonalcoholic steatohepatitis (NASH). Its clinical usefulness in the diagnosis of NASH was evaluated in severely obese patients without or with MS, diabetes, and NASH and the potential roles of the liver and of the adipose tissue in CRP production were characterized.
Severely obese patients without NASH (without MS [N = 13], with MS [N = 11], or with MS and diabetes [N = 7]) and with NASH (without [N = 8] or with [N = 7] MS) were studied. For each patient, liver and adipose tissue biopsies were collected during a bariatric surgery and were used to determine the CRP gene expression by real-time PCR. The role of interleukin-6 (IL6) and lipopolysaccharide in CRP expression was also evaluated in subcutaneous adipose tissue obtained during cosmetic abdominoplasty.
Plasma CRP levels were elevated in severely obese patients independently from the presence or absence of MS, diabetes, or NASH. CRP gene expression was not only increased in livers but also in adipose tissues of obese patients compared with controls subjects. In human adipose tissue, CRP mRNA levels were positively correlated with those of IL-6 and the CRP expression was enhanced in vitro by IL-6 and lipopolysaccharide.
Plasma CRP levels are not predictive of the diagnosis of NASH in severely obese patients. The liver but also the adipose tissue can produce CRP, a process which could be dependent on IL6. Therefore, both tissues might contribute to the elevated plasma CRP levels found in obesity. In addition, the large amount of body fat may well produce an important part of the circulating CRP, further limiting its clinical usefulness in the evaluation of NASH in severely obese patients.
The American Journal of Gastroenterology 09/2006; 101(8):1824-33. · 7.28 Impact Factor
-
Rodolphe Anty,
Soumeya Bekri,
Nathalie Luciani,
Marie-Christine Saint-Paul,
Moncef Dahman,
Antonio Iannelli, Imed Ben Amor,
Aline Staccini-Myx,
Pierre-Michel Huet,
Jean Gugenheim,
Jean-Louis Sadoul,
Yannick Le Marchand-Brustel,
Albert Tran,
Philippe Gual
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: C-Reactive Protein (CRP), a nonspecific marker of inflammation that is moderately elevated in obesity, metabolic syndrome (MS), and type 2 diabetes, has been proposed as a surrogate marker of nonalcoholic steatohepatitis (NASH). Its clinical usefulness in the diagnosis of NASH was evaluated in severely obese patients without or with MS, diabetes, and NASH and the potential roles of the liver and of the adipose tissue in CRP production were characterized.
The American Journal of Gastroenterology 07/2006; 101(8):1824-1833. · 7.28 Impact Factor
