Obesity: The Role of the Gastroenterologist

Authors

DOI:

https://doi.org/10.22516/25007440.1192

Keywords:

Obesity, Gastric Balloon, Bariatrics, GLP-1 Receptor Agonists, Gastrointestinal Endoscopy

Abstract

Background: Obesity is a disease with high prevalence worldwide, and its incidence is increasing, especially in middle- to high-income countries. Its pathophysiology is related to intestinal hormonal regulation and various gastrointestinal conditions.

Introduction: The gastroenterologist plays a crucial role in treating this disease through specialized interventions such as bariatric endoscopy, which contribute to weight loss and reduce comorbidities associated with this condition. Additionally, as more patients undergo weight loss procedures, understanding the adjunctive medical treatment in bariatric procedures becomes essential. This review presents the key elements that the gastroenterologist should consider in managing obesity based on the most recent literature.

Conclusions: There are unmet treatment needs for patients with obesity, among which bariatric endoscopic procedures are a reality when conducted in conjunction with other multidisciplinary approaches.

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Author Biographies

Valeria Atenea Costa Barney, Clínica Palermo

Internist, Gastroenterologist. Bariatric Endoscopist, Clínica Palermo. Bogotá, Colombia.

Daniela Caceres, Hospital Universitario Santa Sofia de Caldas

Internist, Gastroenterologist. Head of the Endoscopy Unit, Hospital Universitario Santa Sofía de Caldas. Manizales, Colombia.

Alfonso Kerguelen, Clínica Marly - Colsanitas

 Internist, Endocrinologist, Clínica Marly, Colsanitas. Bogotá, Colombia.

Jesus Rodriguez, Clínica Shaio

Gastrointestinal Endoscopic Surgeon, Clínica General del Norte, Barranquilla. Endoscopic Surgeon, Clínica Shaio. Bogotá, Colombia.

Andres Rodriguez, Hospital de Santa Inés

Endoscopic Surgeon, Hospital de Santa Inés. Cuenca, Ecuador.

Manoel Galvao Neto, Orlando Health Weight Loss and Bariatric Surgery Institute

Bariatric Endoscopic Surgeon. Orlando Health Weight Loss and Bariatric Surgery Institute. Orlando, USA

References

World Health Organization (WHO). WHO European Regional Obesity Report 2022 [Internet]. Copenhagen: WHO Regional Office for Europe; 2022 [consultado el 15 de enero de 2024]. Disponible en: https://iris.who.int/bitstream/handle/10665/353747/9789289057738-eng.pdf?sequence=1

Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019;381(25):2440-2450. https://doi.org/10.1056/NEJMsa1909301

Alfaris N, Alqahtani AM, Alamuddin N, Rigas G. Global Impact of Obesity. Gastroenterol Clin North Am. 2023;52(2):277-93. https://doi.org/10.1016/j.gtc.2023.03.002

Lobstein T, Jackson-Leach R, Powis J, Brinsden H, GrayWorld M. World Obesity Atlas 2023 [Internet]. World Obesity Federation; 2023 [consultado el 15 de enero de 2024]. Disponible en: https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2023_Report.pdf

Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6-10. https://doi.org/10.1016/j.metabol.2018.09.005

Ulijaszek S. Obesity and environments external to the body. Philos Trans R Soc Lond B Biol Sci. 2023;378(1885):20220226. https://doi.org/10.1098/rstb.2022.0226

Herrán OF, Bermúdez JN, Zea MdP. Cambios alimentarios en Colombia; resultados de dos encuestas nacionales de nutrición, 2010-2015. Salud UIS. 2020;52(1):21-31. https://doi.org/10.18273/revsal.v52n1-2020004

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027-1050. https://doi.org/10.1016/S0140-6736(23)02750-2

Shay JES, Singh A. The Effect of Obesity on Gastrointestinal Disease. Gastroenterol Clin North Am. 2023;52(2):403-15. https://doi.org/10.1016/j.gtc.2023.03.008

Ahern AL, Breeze P, Fusco F, Sharp SJ, Islam N, Wheeler GM, et al. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. Lancet Public Health. 2022;7(10):e866-e75. https://doi.org/10.1016/S2468-2667(22)00226-2

Perdomo CM, Cohen RV, Sumithran P, Clement K, Fruhbeck G. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet. 2023;401(10382):1116-30. https://doi.org/10.1016/S0140-6736(22)02403-5

Schmitz SH, Aronne LJ. The Effective Use of Anti-obesity Medications. Gastroenterol Clin North Am. 2023;52(4):661-80. https://doi.org/10.1016/j.gtc.2023.08.003

Muller TD, Bluher M, Tschop MH, DiMarchi RD. Anti-obesity drug discovery: advances and challenges. Nat Rev Drug Discov. 2022;21(3):201-23. https://doi.org/10.1038/s41573-021-00337-8

Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. https://doi.org/10.1016/j.metabol.2017.12.010

Shi Q, Wang Y, Hao Q, Vandvik PO, Guyatt G, Li J, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet. 2022;399(10321):259-69. https://doi.org/10.1016/S0140-6736(21)01640-8

Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. https://doi.org/10.1056/NEJMoa2032183

Mok J, Adeleke MO, Brown A, Magee CG, Firman C, Makahamadze C, et al. Safety and Efficacy of Liraglutide, 3.0 mg, Once Daily vs Placebo in Patients With Poor Weight Loss Following Metabolic Surgery: The BARI-OPTIMISE Randomized Clinical Trial. JAMA Surg. 2023;158(10):1003-11. https://doi.org/10.1001/jamasurg.2023.2930

Ryan DH, Lingvay I, Colhoun HM, Deanfield J, Emerson SS, Kahn SE, et al. Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT) rationale and design. Am Heart J. 2020;229:61-9. https://doi.org/10.1016/j.ahj.2020.07.008

Lingvay I, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide for cardiovascular event reduction in people with overweight or obesity: SELECT study baseline characteristics. Obesity (Silver Spring). 2023;31(1):111-22. https://doi.org/10.1002/oby.23621

Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-32. https://doi.org/10.1056/NEJMoa2307563

Jastreboff AM, Kaplan LM, Frias JP, Wu Q, Du Y, Gurbuz S, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. N Engl J Med. 2023;389(6):514-26. https://doi.org/10.1056/NEJMoa2301972

Wharton S, Blevins T, Connery L, Rosenstock J, Raha S, Liu R, et al. Daily Oral GLP-1 Receptor Agonist Orforglipron for Adults with Obesity. N Engl J Med. 2023;389(10):877-88. https://doi.org/10.1056/NEJMoa2302392

Abu Dayyeh BK, Bazerbachi F, Vargas EJ, Sharaiha RZ, Thompson CC, Thaemert BC, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022;400(10350):441-51. https://doi.org/10.1016/S0140-6736(22)01280-6

Crossan K, Sheer AJ. Intragastric Balloon. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Amy Sheer declares no relevant financial relationships with ineligible companies; 2024.

Force ABET, Committee AT, Abu Dayyeh BK, Kumar N, Edmundowicz SA, Jonnalagadda S, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015;82(3):425-38 e5. https://doi.org/10.1016/j.gie.2015.03.1964

Neto MG, Silva LB, de Quadros LG, Grecco E, Filho AC, de Amorim AMB, et al. Brazilian Consensus on Endoscopic Sleeve Gastroplasty. Obes Surg. 2021;31(1):70-8. https://doi.org/10.1007/s11695-020-04915-4

Muniraj T, Day LW, Teigen LM, Ho EY, Sultan S, Davitkov P, et al. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. Gastroenterology. 2021;160(5):1799-808. https://doi.org/10.1053/j.gastro.2021.03.003

Dang JT, Switzer NJ, Sun WYL, Raghavji F, Birch DW, Karmali S. Evaluating the safety of intragastric balloon: An analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis. 2018;14(9):1340-7. https://doi.org/10.1016/j.soard.2018.05.003

Ameen S, Merchant HA. Intragastric balloons for obesity: critical review of device design, efficacy, tolerability, and unmet clinical needs. Expert Rev Med Devices. 2024;21(1-2):37-54. https://doi.org/10.1080/17434440.2023.2289691

Alexandre F, Lapergola A, Vannucci M, Pizzicannella M, D’Urso A, Saviano A, et al. Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year. J Visc Surg. 2023;160(2S):S38-S46. https://doi.org/10.1016/j.jviscsurg.2022.12.003

Barrichello S, Hourneaux de Moura DT, Hourneaux de Moura EG, Jirapinyo P, Hoff AC, Fittipaldi-Fernandez RJ, et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study. Gastrointest Endosc. 2019;90(5):770-80. https://doi.org/10.1016/j.gie.2019.06.013

Beran A, Matar R, Jaruvongvanich V, Rapaka BB, Alalwan A, Portela R, et al. Comparative Effectiveness and Safety Between Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy: a Meta-analysis of 6775 Individuals with Obesity. Obes Surg. 2022;32(11):3504-12. https://doi.org/10.1007/s11695-022-06254-y

Seo DJ, Simsek C, Chan WW, Thompson CC, Jirapinyo P. Improvement of gastroesophageal reflux symptoms following endoscopic sleeve gastroplasty. Gastroenterology. 2022;162(7):S-339-S-40. https://doi.org/10.1016/S0016-5085(22)60818-7

Sharaiha RZ, Hajifathalian K, Kumar R, Saunders K, Mehta A, Ang B, et al. Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity. Clin Gastroenterol Hepatol. 2021;19(5):1051-7 e2. https://doi.org/10.1016/j.cgh.2020.09.055

Wang JW, Chen CY. Current status of endoscopic sleeve gastroplasty: An opinion review. World J Gastroenterol. 2020;26(11):1107-12. https://doi.org/10.3748/wjg.v26.i11.1107

Lopez-Nava G, Bautista-Castano I, Jimenez A, de Grado T, Fernandez-Corbelle JP. The Primary Obesity Surgery Endolumenal (POSE) procedure: one-year patient weight loss and safety outcomes. Surg Obes Relat Dis. 2015;11(4):861-5. https://doi.org/10.1016/j.soard.2014.09.026

Reja D, Zhang C, Sarkar A. Endoscopic bariatrics: current therapies and future directions. Transl Gastroenterol Hepatol. 2022;7:21. https://doi.org/10.21037/tgh.2020.03.09

Singh S, Bazarbashi AN, Khan A, Chowdhry M, Bilal M, de Moura DTH, et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc. 2022;36(1):252-66. https://doi.org/10.1007/s00464-020-08267-z

de Oliveira GHP, de Moura DTH, Funari MP, McCarty TR, Ribeiro IB, Bernardo WM, et al. Metabolic Effects of Endoscopic Duodenal Mucosal Resurfacing: a Systematic Review and Meta-analysis. Obes Surg. 2021;31(3):1304-12. https://doi.org/10.1007/s11695-020-05170-3

Mingrone G, van Baar AC, Deviere J, Hopkins D, Moura E, Cercato C, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial. Gut. 2022;71(2):254-64. https://doi.org/10.1136/gutjnl-2020-323608

Schmitz SH, Aronne LJ. The Effective Use of Anti-obesity Medications. Gastrointest Endosc Clin N Am. 2023;52:661-80. https://doi.org/10.1016/j.gtc.2023.08.003

Barrichello S, Hourneaux de Moura DT, Hourneaux de Moura EG, Jirapinyo P, Hoff AC, Fittipaldi-Fernandez RJ, et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study. Gastrointestinal Endoscopy. 2019;90(5):770-780. https://doi.org/10.1016/j.gie.2019.06.013

Figura 1. Posicionamiento subcardial como punto de referencia para el inicio de la insuflación del balón. Imagen propiedad de los autores.

Published

2024-09-30

How to Cite

Costa Barney, V. A., Caceres, D., Kerguelen, A., Rodriguez, J., Rodriguez, A., & Galvao Neto, M. (2024). Obesity: The Role of the Gastroenterologist. Revista Colombiana De Gastroenterología, 39(3), 287–295. https://doi.org/10.22516/25007440.1192

Issue

Section

Review articles