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JAAPA : Official Journal of the... Jan 2020Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. The goal is to maintain A1C less than 7% in most... (Review)
Review
Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. The goal is to maintain A1C less than 7% in most patients and prevent damage to other organs such as the kidneys and heart. Patients who are obese and cannot achieve normal blood glucose levels despite diet, exercise, and multiple medications may be considered for bariatric surgery. The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve A1C, reduce weight, and reduce the number of medications patients need for diabetes management. Comorbidities such as hyperlipidemia and hypertension also may improve. This article describes types of bariatric surgery, proper selection of surgical candidates, patient education, and the postoperative patient management necessary for long-term success in improving blood glucose control.
Topics: Avitaminosis; Bariatric Surgery; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Hypoglycemia; Hypoglycemic Agents; Life Style; Malabsorption Syndromes; Obesity; Patient Education as Topic; Patient Selection; Postoperative Care; Postoperative Complications; Weight Loss; Weight Reduction Programs
PubMed: 31880647
DOI: 10.1097/01.JAA.0000615484.77430.1b -
Gastroenterology Clinics of North... Dec 2019
Topics: Humans; Malabsorption Syndromes
PubMed: 31668188
DOI: 10.1016/j.gtc.2019.08.013 -
Duodecim; Laaketieteellinen... 2015Autoimmune enteropathy (AIE) is characterized by protracted diarrhea, malabsorption, immunomediated damage to the intestinal mucosa, and unresponsiveness to changes in... (Review)
Review
Autoimmune enteropathy (AIE) is characterized by protracted diarrhea, malabsorption, immunomediated damage to the intestinal mucosa, and unresponsiveness to changes in diet. The disease is mainly manifested in the small intestine. Lymphocyte deposits are present on the mucous membrane, and anti-enterocyte or anti-goblet cell antibodies have been described in the majority of affected persons. AIE occurs primarily in infants. Immunosuppressive drugs have been used with varying success. The prognosis of AlE is dependent on the degree of severity of the damage to the intestinal mucosa and extraintestinal symptoms and diseases associated therewith.
Topics: Autoimmune Diseases; Diarrhea; Humans; Immunosuppressive Agents; Intestinal Mucosa; Intestine, Small; Malabsorption Syndromes; Prognosis; Risk Factors
PubMed: 26237896
DOI: No ID Found -
Clinical Nutrition (Edinburgh, Scotland) Dec 2023Lactose malabsorption is a very common condition due to intestinal lactase deficiency. Post weaning, a genetically programmed and irreversible reduction of lactase...
Lactose malabsorption is a very common condition due to intestinal lactase deficiency. Post weaning, a genetically programmed and irreversible reduction of lactase activity occurs in the majority of the world's population. Lactose malabsorption does not necessarily result in gastrointestinal symptoms, i.e. lactose intolerance, which occurs in approximately one third of those with lactase deficiency. In the absence of well-established guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Mainly in particular categories, such as the older adults, the approach to lactose malabsorption may deserve careful considerations. Milk and dairy products are an important supply of a wide range of nutrients that contribute to meet the nutritional needs in different life stages. Dietary composition can significantly impact the mechanisms leading to age-related loss of bone mineral density, skeletal muscle mass or function and overall risk of sarcopenia. Moreover, in the latest years, different lines of evidence have highlighted an association between dairy intake and prevention of chronic diseases as well as all-cause mortality. The aim of this opinion paper is to provide an overview of lactose malabsorption and intolerance in the older adults and their implications in clinical practice.
Topics: Humans; Aged; Animals; Lactose Intolerance; Milk; Gastrointestinal Diseases; Diet; Malabsorption Syndromes; Lactase; Lactose
PubMed: 37931373
DOI: 10.1016/j.clnu.2023.10.014 -
Physiology (Bethesda, Md.) Nov 2017It has been 30 years since the intestinal sodium glucose cotransporter SGLT1 was cloned, and, in the intervening years, there have been many advances that have... (Review)
Review
It has been 30 years since the intestinal sodium glucose cotransporter SGLT1 was cloned, and, in the intervening years, there have been many advances that have influenced physiology and medicine. Among the first was that SGLT1 is the founding member of the human gene family SLC5, containing 11 diverse transporters and a glucose sensor. Equally surprising was that SGLTs are members of a structural family of cotransporters and exchangers in different gene families. This led to the conclusion that these proteins operate by a mechanism where transport involves the opening and closing of external and internal gates. The mechanism is shared by a wide variety of transporters in different structural families, e.g., the human facilitated glucose transporters (SLC2) in the huge major facilitator superfamily (MFS). Not surprising is the finding that mutations in genes cause the rare diseases glucose-galactose-malabsorption (GGM) and familial renal glucosuria (FRG). However, it was not envisaged that SGLT inhibitors would be used to treat diabetes mellitus, and these drugs may be able to treat cancer. Finally, in 2017, we have just learned that SGLT1 may be required to resist infection and to avoid recurrent pregnancy loss.
Topics: Animals; Carbohydrate Metabolism, Inborn Errors; Glucose; Humans; Malabsorption Syndromes; Sodium-Glucose Transport Proteins
PubMed: 29021363
DOI: 10.1152/physiol.00021.2017 -
Best Practice & Research. Clinical... Apr 2016This review focuses on the acquired causes, diagnosis, and treatment of intestinal malabsorption. Intestinal absorption is a complex process that depends on many... (Review)
Review
This review focuses on the acquired causes, diagnosis, and treatment of intestinal malabsorption. Intestinal absorption is a complex process that depends on many variables, including the digestion of nutrients within the intestinal lumen, the absorptive surface of the small intestine, the membrane transport systems, and the epithelial absorptive enzymes. Acquired causes of malabsorption are classified by focussing on the three phases of digestion and absorption: 1) luminal/digestive phase, 2) mucosal/absorptive phase, and 3) transport phase. Most acquired diseases affect the luminal/digestive phase. These include short bowel syndrome, extensive small bowel inflammation, motility disorders, and deficiencies of digestive enzymes or bile salts. Diagnosis depends on symptoms, physical examination, and blood and stool tests. There is no gold standard for the diagnosis of malabsorption. Further testing should be based on the specific clinical context and the suspected underlying disease. Therapy is directed at nutritional support by enteral or parenteral feeding and screening for and supplementation of deficiencies in vitamins and minerals. Early enteral feeding is important for intestinal adaptation in short bowel syndrome. Medicinal treatment options for diarrhoea in malabsorption include loperamide, codeine, cholestyramine, or antibiotics.
Topics: Humans; Intestinal Absorption; Malabsorption Syndromes; Nutritional Requirements; Parenteral Nutrition
PubMed: 27086886
DOI: 10.1016/j.bpg.2016.03.001 -
Frontiers in Endocrinology 2021Levothyroxine (L-T4) absorption can be impaired by various causes: a) L-T4 ingestion during breakfast, or with food; b) conditions of reduced gastric acidity; c)... (Review)
Review
Levothyroxine (L-T4) absorption can be impaired by various causes: a) L-T4 ingestion during breakfast, or with food; b) conditions of reduced gastric acidity; c) intestinal procedures and diseases such as bariatric surgery, lactose intolerance (LI), celiac disease (CD), inflammatory bowel disease; d) drugs that alter L-T4 absorption, increasing the gastric pH, or preventing the dissolution of tablets. The development of new oral formulations, i.e. the liquid preparation and the soft gel capsule, represents the most recent advance regarding L-T4 therapy. Treating hypothyroidism with L-T4 tablets can lead to an improper control of thyroid-stimulating hormone (TSH) in ~10%-15% of patients. The improperly elevated TSH is usually managed by increasing the L-T4 daily dose, and revaluating TSH upon 2-6 months. The increase of the L-T4 dosage may cause iatrogenic hyperthyroidism, especially when the underlying disorders are cured. Liquid L-T4 can be administered in patients unable to swallow capsules or tablets, and this is one of its major benefits. Liquid L-T4 can: 1- overcome food and beverages interference; 2- bypass the malabsorption associated with an increased gastric pH; 3- circumvent the issue of malabsorption in patients who underwent bariatric surgery; 4-maintain TSH values under control better than L-T4 tablets in hypothyroid patients with typical or atypical CD, or in patients with LI. Few clinical studies evaluated soft gel L-T4 with encouraging findings in patients with gastric- or coffee-related malabsorption, or hypothyroid patients without malabsorption. Additional research is necessary to investigate liquid L-T4, or soft gel capsule, in other conditions of altered L-T4 absorption.
Topics: Administration, Oral; Hormone Replacement Therapy; Humans; Malabsorption Syndromes; Thyroxine
PubMed: 33708175
DOI: 10.3389/fendo.2021.626371 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2016To study the diagnosis and treatment of non-alcoholic Wernicke-Korsakoff syndrome (WKS).
AIM
To study the diagnosis and treatment of non-alcoholic Wernicke-Korsakoff syndrome (WKS).
MATERIAL AND METHODS
Eight patients (5 men and 3 women), mean age 38,9±1,4 years, with WKS developed due to acute gastrointestinal tract (GIT) disease (3 patients), the exacerbation of chronic GIT disease with malabsorption (2 patients) and after surgery on the upper GIT (3 patients) were included in the study.
RESULTS
The disease manifested with consciousness disturbance, symptoms of ataxia, eye movement disorders and bulbar syndrome that developed after 24-48 h. Treatment resistant tonic-clonic seizures were developed in 1 patient. MRI revealed hyper intensive signals on T2-weighted images in the hypothalamus, mamillar bodies, brain stem, hippocampus as well as contrast accumulation in the mamillar bodies. Treatment with vitamin B complex (neurobion) and thiamine exerted a positive effect.
CONCLUSION
Patients with GIT disease with malabsorption are at risk of WKS. Consciousness disturbance, symptoms of ataxia, eye movement disorders indicate the necessity of treatment with thiamine that allows to prevent the development of stable cognitive deficit.
Topics: Adult; Aged; Brain; Cognitive Dysfunction; Female; Humans; Korsakoff Syndrome; Magnetic Resonance Imaging; Malabsorption Syndromes; Male; Middle Aged; Thiamine; Vitamin B Complex; Young Adult
PubMed: 27500869
DOI: 10.17116/jnevro2016116714-11 -
Journal of Human Nutrition and... Jun 2020Metabolic bone diseases are a group of conditions that are common complications in patients with intestinal failure. These may occur as a result of the underlying... (Review)
Review
Metabolic bone diseases are a group of conditions that are common complications in patients with intestinal failure. These may occur as a result of the underlying condition, leading to intestinal failure, particularly inflammatory conditions such as Crohn's disease and their associated treatments including corticosteroids. Malabsorption, as a result of a loss of enterocyte mass or gut function, of many nutrients, including vitamin D, may further compound metabolic bone problems, and there has been historical contamination of parenteral nutrition with aluminium that has prevented normal bone metabolism contributing to osteoporosis. This review looks at the diagnosis and current management of bone health in patients with intestinal failure.
Topics: Bone Diseases, Metabolic; Disease Management; Humans; Intestinal Absorption; Intestinal Diseases; Malabsorption Syndromes
PubMed: 31823437
DOI: 10.1111/jhn.12726 -
Journal of Gastrointestinal Surgery :... Aug 2022Survival following oesophagectomy for cancer is improving, resulting in increased focus on quality of life and survivorship. Malabsorption syndrome is multifactorial and... (Review)
Review
BACKGROUND
Survival following oesophagectomy for cancer is improving, resulting in increased focus on quality of life and survivorship. Malabsorption syndrome is multifactorial and includes exocrine pancreatic insufficiency (EPI), small intestinal bacterial overgrowth (SIBO) and bile acid malabsorption (BAM). The aim of this study was to evaluate the reported incidence and management of malabsorption syndromes post-oesophagectomy.
METHODS
A systematic search of PubMed, EMBASE, MEDLINE, Scopus and the Cochrane Library evaluating incidence, diagnosis and management of malabsorption was performed for studies published until December 2021.
RESULTS
Of 464 identified studies, eight studies (n = 7 non-randomised longitudinal studies) were included where patients were identified with malnutrition following oesophagectomy. Studies included a combined sample of 328 (range 7-63) patients. Malabsorption syndromes including EPI, SIBO and BAM occurred in 15.9-100%, 37.8-100% and 3.33-100% over 21 days-60 months, 1-24 months and 1-24 months respectively. There was no consensus definition for EPI, SIBO or BAM, and there was variation in diagnostic methods. Diagnostic criteria varied from clinical (gastrointestinal symptoms or weight loss), or biochemical (faecal elastase, hydrogen breath test and Selenium-75-labelled synthetic bile acid measurements). Treatment modalities using pancreatic enzyme replacement, rifaximin or colesevelam showed improvement in symptoms and weight in all studies, where investigated.
CONCLUSIONS
Malabsorption syndromes following oesophagectomy are under-recognised, and thus under-reported. The resultant gastrointestinal symptoms may have a negative effect on post-operative quality of life. Current literature suggests benefit with outlined therapies; however, greater understanding of these conditions, their diagnosis and management is required to further understand which patients will benefit from treatment.
Topics: Bile Acids and Salts; Esophagectomy; Exocrine Pancreatic Insufficiency; Humans; Incidence; Malabsorption Syndromes; Quality of Life
PubMed: 35484473
DOI: 10.1007/s11605-022-05323-y