La chirurgie metabolique, vers une (r)evolution de la chirurgie bariatrique ?

in Revue Médicale de Liège (2011), 66(4), 183-90

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes ... [more ▼]

Bariatric surgery has proven its efficacy to obtain a marked and sustained weight loss and dramatically improves metabolic control in obese patients. The frequently observed remission of type 2 diabetes occurs very early, before any marked weight reduction. Increasing evidence suggests that this favourable effect results from profound changes in gut hormones involved in the regulation of energy intake behaviour and glucose homeostasis rather than simply from mechanical food restriction or malabsorption imposed by the surgical procedure. The better knowledge of these pathophysiological mechanisms, especially well studied with Roux-en Y gastric bypass, resulted in recent innovation in the technical procedures leading to a shift from bariatric surgery to metabolic surgery. Such type of surgery is currently evaluated in patients with type 2 diabetes, but with only a moderate obesity (BMI < 35 kg/m2), or even without obesity (BMI < 30 kg/m2). The Belgian Metabolic Intervention (BMI) Study Group would like to contribute very soon to this evaluation in a multidisciplinary approach. [less ▲]

La vignette thérapeutique de l'étudiant. Prise en charge d'une personne obèse avec syndrome métabolique

in Revue Médicale de Liège (2009), 64(12), 651-656

The management of an obese person requires a careful evaluation first, a multidisciplinary approach and a stepwise therapeutic strategy. The latter should favour lifestyle modifications, eventually the ... [more ▼]

The management of an obese person requires a careful evaluation first, a multidisciplinary approach and a stepwise therapeutic strategy. The latter should favour lifestyle modifications, eventually the use pharmacological agents in good responders, and reserve bariatric surgery to well selected cases, refractory to medical treatment. Continuous motivational reinforcement is crucial for long-term success. In obese individuals at high metabolic risk, such strategy should aim at reducing the incidence of new-onset type 2 diabetes. [less ▲]

Estimation du debit de filtration glomérulaire chez le patient obese: performances des équations basées sur la créatinine et la cystatine C

in Néphrologie & Thérapeutique (2009), 5(5), 003

Le traitement du diabète de type 2: entre insulinosensibilisateurs et insulinosécrétagogues

in Revue Médicale de Liège (2007), 62 Spec No

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease ... [more ▼]

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease in a particular patient. Besides the lifestyle changes, the treatment strategy comprises the administration of agents that promote insulin secretion and/or that improve insulin sensitivity. Drugs facilitating weight loss also improve glucose control by reducing insulin resistance. A global approach should be recommended to reduce the high cardiovascular risk of diabetic patients. The present article aims at summarizing our contribution to the development of drugs designed for the treatment of type 2 diabetes. [less ▲]

Indexing glomerular filtration rate for body surface area is useful in obese subjects - Reply

in Nephrology Dialysis Transplantation (2006), 21(3), 821-822

Indexing glomerular filtration rate for body surface area in obese patients is misleading: concept and example

in Nephrology Dialysis Transplantation (2005), 20(10), 2024-2028

L'etude clinique du mois. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."

in Revue Médicale de Liège (2005), 60(2), 121-5

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese ... [more ▼]

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. The follow-up rate for laboratory examinations was 74.5 percent at 10 years. At that time, data of 627 patients of the control group (mean age of 48 years, body mass index of 41 kg/m2) were compared to those of 641 patients who were submitted to surgery (banding n = 156, vertical banded gastroplasty n = 451 and gastric bypass n =34). At 10 years, the body weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group (p < 0.001), and similar changes were observed for waist circumference (+2.8 percent versus -10.1 percent, respectively, p < 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Ten-year rates of recovery from diabetes, hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricaemia were more favourable in the surgery than in the control group. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridaemia, and hyperuricaemia (but not of hypertension) than the control group. In conclusion, as compared with conventional therapy, bariatric surgery appears to be a valuable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolaemia that was not significantly affected, amelioration in cardiovascular risk factors that were elevated at baseline. Obtaining long-term data concerning the effect of weight loss on overall mortality and on the incidence rates of myocardial infarction, stroke, and cancer remains a key-objective of this landmark study. [less ▲]

Detection of renal failure in overweight patients.

in Kidney International (2004)

Estimation du débit de filtration glomérulaire chez le patient obèse.

in Néphrologie (2004), 24(5), 28

Y a-t-il une place d'emblée pour une bithérapie faiblement dosée dans le traitement de l'hypertension artérielle essentielle?

in Médecine et Hygiène (2003), 61

If the treatment of hypertension is very useful to decrease the cardiovascular risk, the way to get the normalisation of high blood pressure is difficult in spite of many families of antihypertensive ... [more ▼]

If the treatment of hypertension is very useful to decrease the cardiovascular risk, the way to get the normalisation of high blood pressure is difficult in spite of many families of antihypertensive agents with different mechanisms of action. To reach such objective, association of different drugs are most often required. But, the european guidelines for the management of hypertension have just been released and proposed the possibility to begin very-low-dose combination therapy first-line. These associations offer immediate higher efficacy, excellent tolerance and low cost. [less ▲]