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GIT j club obesity women.
1. Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT Surgery
Weekly J ClubWeekly J Club
Supervised by:Supervised by:
Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani
2. Introduction:Introduction:
Obesity is a well-known, chronic condition affects all ages.Obesity is a well-known, chronic condition affects all ages.
The obesity epidemic has significant impact from social stigma toThe obesity epidemic has significant impact from social stigma to
costly, comorbid diseases.costly, comorbid diseases.
Gender differences exist between women & men as omen are moreGender differences exist between women & men as omen are more
likely:likely:
(1) Dissatisfied with their weight.(1) Dissatisfied with their weight.
(2) Dissatisfied with their body.(2) Dissatisfied with their body.
(3) Associate body image with self-esteem.(3) Associate body image with self-esteem.
3. Epidemiology:Epidemiology:
The prevalence is similar in women &men, with 1/3 adults beingThe prevalence is similar in women &men, with 1/3 adults being
obese.obese.
Gender diff in the prevalence occur in certain subpopulations,non-Gender diff in the prevalence occur in certain subpopulations,non-
Hispanic African American women ,older women (age >60)Hispanic African American women ,older women (age >60)
More severe forms of obesity affect women more than men.More severe forms of obesity affect women more than men.
4. GIT Diseases in obese women:GERDGIT Diseases in obese women:GERD
Obesity is a known risk factor for GERD.Obesity is a known risk factor for GERD.
Similar prevalence of symptomatic GERD in women & men.Similar prevalence of symptomatic GERD in women & men.
GERD complications;erosive esophagitis,Barrett & EAC, are lessGERD complications;erosive esophagitis,Barrett & EAC, are less
common incommon in women.women.
Central adiposity is less common in women than men, may explainCentral adiposity is less common in women than men, may explain
the lower complications in women.the lower complications in women.
Sex hormones implicated to explain different GERD manifestations.Sex hormones implicated to explain different GERD manifestations.
Medical management, including behavioral modifications & acidMedical management, including behavioral modifications & acid
suppressive, is effective in ameliorating GERD symptoms.suppressive, is effective in ameliorating GERD symptoms.
Weight loss resulting from surgical or diet/lifestyle interventionsWeight loss resulting from surgical or diet/lifestyle interventions
can reduce or eliminate the symptoms of GERD:can reduce or eliminate the symptoms of GERD:
(1) Dose-response relation between wt loss & symptoms(1) Dose-response relation between wt loss & symptoms
resolution.resolution.
(2) Women derive benefit from smaller amounts of weight loss(2) Women derive benefit from smaller amounts of weight loss
5. GIT Diseases in obese women:NAFLDGIT Diseases in obese women:NAFLD
Strong correlations between NAFLD / obesity in women.Strong correlations between NAFLD / obesity in women.
Prevalence of NAFLD is similar in women & men.Prevalence of NAFLD is similar in women & men.
NAFLD is less common in premenopausal women versus age-NAFLD is less common in premenopausal women versus age-
matched men.matched men.
Sex hormones are also linked to obesity / NAFLD.Sex hormones are also linked to obesity / NAFLD.
Perimenopausal / postmenopausal women have lower estrogen &Perimenopausal / postmenopausal women have lower estrogen &
increased androgens, favors the development of the metabolicincreased androgens, favors the development of the metabolic
syndrome and NAFLD via increased visceral fat deposition.syndrome and NAFLD via increased visceral fat deposition.
The suggested protective effect of female sex hormonesThe suggested protective effect of female sex hormones
(1) Alower prevalence of NAFLD in premenopausal women(1) Alower prevalence of NAFLD in premenopausal women
compared with men of the same agecompared with men of the same age
(2) Women with NAFLD have significantly lower estradiol compared(2) Women with NAFLD have significantly lower estradiol compared
with those without NAFLD.with those without NAFLD.
(3) Women >50 have a higher prevalence of NAFLD(3) Women >50 have a higher prevalence of NAFLD
6. GIT Diseases in obese women:NAFLDGIT Diseases in obese women:NAFLD
Weight loss is typically recommended for obese patients withWeight loss is typically recommended for obese patients with
NAFLD; but effect on the natural history of the disease is unclear.NAFLD; but effect on the natural history of the disease is unclear.
Modest weight loss of 5-10% or more can correct abnormal liverModest weight loss of 5-10% or more can correct abnormal liver
chemistries&decrease liver size, fat content &steatohepatitis.chemistries&decrease liver size, fat content &steatohepatitis.
Rapid weight loss after gastric bypass surgery, very-low-calorieRapid weight loss after gastric bypass surgery, very-low-calorie
diets, or prolonged fasting,lowers hepatic fat content but candiets, or prolonged fasting,lowers hepatic fat content but can
induce hepatic inflammation, worsening steatohepatitis,so slow,induce hepatic inflammation, worsening steatohepatitis,so slow,
gradual weight loss is essential.gradual weight loss is essential.
NAFLD in women is also linked to DM, MS, low estrogen &elevatedNAFLD in women is also linked to DM, MS, low estrogen &elevated
androgen.androgen.
Premenopausal women have a lower prevalence of NAFLD, likelyPremenopausal women have a lower prevalence of NAFLD, likely
due to the protective effect of estrogen.due to the protective effect of estrogen.
Effective trt of NAFLD includes slow, gradual weight loss.Effective trt of NAFLD includes slow, gradual weight loss.
7. GIT Diseases in obese women:ObesityGIT Diseases in obese women:Obesity
Obesity increase the prevalence of GSs in women specially inObesity increase the prevalence of GSs in women specially in
child-bearing age.child-bearing age.
Parity further increase the risk.Parity further increase the risk.
HRT increase the risk.HRT increase the risk.
Ocs (not low estrogen) increase the risk.Ocs (not low estrogen) increase the risk.
URSO effective at preventing gallstone formation inURSO effective at preventing gallstone formation in obese women.obese women.
Editor's Notes
Irritable Bowel Syndrome Slide Cover
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS was long dismissed as a psychosomatic condition.1 It has no clear etiology or pathophysiology, affects mainly women, and is not fatal.2
However, attitudes are changing as physicians learn more about the pathophysiology of IBS.
The incidence and prevalence of IBS have not been extensively monitored, so it is difficult to discern historical trends. Also, only a small proportion of IBS sufferers seek treatment,3 and diagnosis of the condition is difficult.4
References:
1.Maxwell PR, Mendall MA, Kumar D. Irritable bowel syndrome. Lancet. December 1997;350:1691-1695.
2. Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. August 1990;99:409-415.
3. Drossman DA, Thompson WG. The irritable bowel syndrome: review and a graduated multicomponent treatment approach. Ann Intern Med. June 1992;116(pt 1):1009-1016.
4. Paterson WG, Thompson WG, Vanner SJ, et al. Recommendations for the management of irritable bowel syndrome in family practice. Can Med Assoc J. July 1999;161:154-160.
IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2
IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3
Features of disordered defecation include3
Urgency
Altered stool consistency
Altered stool frequency
Incomplete evacuation
References:
1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172.
2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14.
3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2
IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3
Features of disordered defecation include3
Urgency
Altered stool consistency
Altered stool frequency
Incomplete evacuation
References:
1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172.
2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14.
3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2
IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3
Features of disordered defecation include3
Urgency
Altered stool consistency
Altered stool frequency
Incomplete evacuation
References:
1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172.
2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14.
3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
IBS is one of over 20 functional gastrointestinal (GI) disorders.1 The functional GI disorders vary clinically and are characterized by chronic or recurrent symptoms not explained by structural or biochemical abnormalities. It appears that these disorders relate to abnormalities in motility and/or afferent sensitivity as modulated by the central nervous system.2
IBS is defined as a functional bowel disorder in which abdominal pain is associated with a change in bowel habit with features of disordered defecation.3
Features of disordered defecation include3
Urgency
Altered stool consistency
Altered stool frequency
Incomplete evacuation
References:
1. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. December 1990;3:159-172.
2. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther. 1999;13(suppl 2):3-14.
3. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(suppl 2):1143-1147.
