Obezita se stala v posledních 30 letech celosvětovou pandemií. V léčbě obezity se v současnosti uplatňuje především úprava životního stylu, která však mnohdy dlouhodobě selhává. Pro příští desetiletí se jako perspektivní jeví v léčbě obezity spolu s chirurgickou léčbou dlouhodobé podávání antiobezitik, tedy léků, které příznivě ovlivňují nejen pokles nadměrné hmotnosti, ale i zdravotní rizika spojená s obezitou. Tento text podává přehled o současných možnostech farmakoterapie obezity včetně jejich indikací, vhodném výběru pacienta a nežádoucích účincích léčby. Přináší také přehled studií, které prokazují dlouhodobou účinnost a bezpečnost této léčby. Přesto, že účinná a bezpečná antiobezitika jsou v současné době k dispozici, není tato léčba ani částečně hrazena ze všeobecného zdravotního pojištění. Náklady na léčbu jsou však pro velkou část obézních dlouhodobě neúnosné. Faktická nedostupnost účinných antiobezitik pro indikované pacienty má závažné zdravotně-ekonomické dopady. Nevyužívání účinných možností léčby, potvrzených postupy medicíny založené na důkazech, má za následek vysokou prevalenci s obezitou spojených nemocí, jejichž léčení je ekonomicky ještě nákladnější a v případě diabetes mellitus 2. typu dokonce méně efektivní. Jsme přesvědčeni, že alespoň částečná úhrada antiobezitik z prostředků všeobecného zdravotního pojištění pro pacienty s prokázanou compliance a za jasně vymezených podmínek je nezbytným krokem ke zlepšení situace a ve svých důsledcích bude jednoznačně ekonomicky prospěšná.

Obesity has become a worldwide pandemic in the last thirty years. Its treatment is primarily based on the life-style changes that, however, often fail in the long-term run. For the next decade, major perspectives in the successful obesity treatment include, in addition to bariatric surgery, a long-term treatment with anti-obesity drugs, in particular the ones that in addition to weight reduction also directly affect obesity-related pathologies. This paper summarizes current possibilities of obesity pharmacotherapy including its indication, proper selection of patients and side effects of anti-obesity drugs. It also reviews the studies describing long-term efficacy and safety of anti-obesity drugs. Despite the availability of efficacious and safe anti-obesity drugs, these therapies are not even partially covered by health insurance. The costs of anti-obesity drugs are for the majority of patients with obesity unacceptably high. The actual unavailability of anti-obesity drugs for patients with obesity has significant health-economic consequences. Limited use of these medications that have evidence-based data supporting their efficacy, contributes to high prevalence of obesity-related pathologies with subsequent low treatment efficacy and high treatment costs. We believe that at least partial reimbursement of anti-obesity drugs from general health insurance, in patients with verified compliance and under clearly defined conditions, is a necessary step to improve this situation which could lead to clearly economically effective results.

• MeSH
• hodnocení léčiv MeSH
• kombinovaná farmakoterapie MeSH
• látky proti obezitě aplikace a dávkování   klasifikace   terapeutické užití   MeSH
• léčba obezity * MeSH
• lidé MeSH
• liraglutid aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• náklady na léky MeSH
• nežádoucí účinky léčiv MeSH
• obezita * farmakoterapie   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a newer metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report outcomes in a cohort of LGCP patients at 5-year follow-up. METHODS: Body mass index (BMI, kg/m2) evolution, excess weight loss (%EWL), excess BMI loss (%EBMIL), and total weight loss (%TWL) were recorded. Repeated measures analysis of variance (ANOVA) was used to assess BMI change over 5 years. Two-step cluster analysis was used to profile LGCP patients according to significant characteristics relative to successful 5-year weight loss. RESULTS: Of patients entering the study between 2010 and 2011 with complete weight data through 5-year follow-up (86.9%, 212/244), mean age was 45.8 ± 10.9 years; mean baseline BMI, 41.4 ± 5.5 (81.6% women); 58 patients (27.4%) had type 2 diabetes. Mean operative time was 69.0 min; mean hospitalization, 38 h (24-72). ANOVA indicated a significant BMI reduction out to 2 years (p < 0.001), a plateau at 3 and 4 years, and a moderate but significant BMI increase at 5 years (p < 0.01). EBMIL at 1, 2, 3, 4, and 5 years was as follows: 50.7 ± 9.1%, 61.5 ± 8.1%, 60.2 ± 7.0%, 58.5 ± 7.0%, and 56.8 ± 6.3%. At 5 years, 79.2% (168/212) of patients were successful; 20.8% (44/212) experienced a suboptimal weight outcome; mean weight regain, 9.2%. Cluster analysis identified four distinct LGCP patient profiles. Diabetes improvement rate was 65.5%. There were 12 reoperations (4.9%): 4 emergency (1.6%) and 8 (3.3%) elective. There was no mortality. CONCLUSIONS: At 5-year follow-up, LGCP proved to be safe and effective, with 56.8% EBMIL and a low rate of complications.

• MeSH
• bariatrická chirurgie škodlivé účinky   metody   statistika a číselné údaje   MeSH
• délka operace MeSH
• diabetes mellitus 2. typu epidemiologie   chirurgie   MeSH
• dospělí MeSH
• gastrektomie metody   MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• laparoskopie škodlivé účinky   metody   statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita epidemiologie   chirurgie   MeSH
• následné studie MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

SCOPE: The major alimentary sources for the plasma membrane lipid sphingomyelin (SM) are dairy products, eggs, and meat. We recently reported that the SM metabolite ceramide induces cathepsin D mediated apoptosis in murine intestinal epithelial cells (IECs) and increases inflammation in acute colitis. We investigated the impact of SM and phosphatidylcholine on apoptosis in human IECs and point out BH3-interacting death agonist (BID) as link between cathepsin D and apoptosis. METHODS AND RESULTS: HT-29 and isolated human IECs were stimulated with SM or phosphatidylcholine. SM treatment resulted in increased apoptosis. Phosphatidylcholine showed contrary effects. Western revealed higher amounts of cathepsin D and BID activation upon lipid stimulation. Western blotting revealed BID activation through SM in both an induced and a spontaneous mouse model of colitis. CONCLUSION: Dietary phospholipids may induce or abolish apoptosis in IECs and seem to play a role in the pathogenesis of inflammatory bowel diseases. This nutritional factor might be considered when evaluating the pathogenesis of inflammatory bowel diseases. Effects of SMase- and SM treatment on inflammation in dextran sulfate sodium induced animal models of colitis and in vitro experiments are discussed as controversial. Variable sources of SM, feeding techniques, and mouse strains might play a role.Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

• MeSH
• adhezní spoje MeSH
• apoptóza * účinky léků   MeSH
• buněčná smrt účinky léků   MeSH
• buňky HT-29 účinky léků   MeSH
• ceramidy metabolismus   MeSH
• epitelové buňky * patologie   účinky léků   MeSH
• fosfatidylcholiny farmakologie   metabolismus   MeSH
• kathepsin D metabolismus   MeSH
• kolitida metabolismus   patologie   MeSH
• kultivované buňky MeSH
• lidé MeSH
• liposomy farmakologie   MeSH
• myši inbrední C57BL MeSH
• potravní doplňky MeSH
• protein Bid metabolismus   MeSH
• sfingomyelinfosfodiesterasa metabolismus   MeSH
• sfingomyeliny farmakologie   metabolismus   MeSH
• střeva * cytologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• zvířata MeSH

In 2012, an expert panel composed of presidents of each of the societies, the European Chapter of the International Federation for the Surgery of Obesity (IFSO-EC), and of the European Association for the Study of Obesity (EASO), as well as of the chair of EASO Obesity Management Task Force (EASO OMTF) and other key representatives from IFSO-EC and EASO, devoted the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery in advance of the 2013 European Congress on Obesity held in Liverpool. This meeting was prompted by the extraordinary advancement made in the field of metabolic and bariatric surgery during the past decade. It was agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced by focusing in particular on the evidence gathered in relation to the effects on diabetes and the changes in the recommendations of patient eligibility criteria. The expert panel allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

• MeSH
• bariatrická chirurgie * metody   psychologie   normy   MeSH
• diabetes mellitus 2. typu chirurgie   MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• obezita komplikace   psychologie   chirurgie   MeSH
• pooperační péče MeSH
• předoperační péče MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

In the beginning of the 21st century obesity still represents health, social and economical threat for most of economically wealthy countries worldwide. Estimated direct costs for obesity and related comorbidities treatment exceed 5% of the total health care costs both in the US and in European Union. However, in addition there are obesity-related indirect costs linked to more frequent work sickness leave, higher unemployment rates and overall lower productivity of obese patients. Surgical treatment of obesity (bariatric surgery) is the most effective long-term treatment modality for those patients suffering from higher degrees of obesity. Bariatric surgery has not only positive effects on weight loss, but is also extremely effective in improving or resolving many of obesity-related comorbidities, which have evolved rapidly into the so-called metabolic surgery. T2DM may serve as excellent example of metabolic, obesity-related comorbidity which can be treated with bariatric-metabolic procedure even without direct relation to weight loss. In such cases bariatric surgery evolves into metabolic surgery. Thus metabolic operations (namely from the malabsorptive end) deeply influence hormonal secretion especially in the proximal part of small bowel, change parametres of entero-insular axis and have positive influence on insulin secretion, sensitivity and on the entire complex of glucose tolerance. Nowadays we can witness dramatic changes in perception of T2DM from bariatric surgeons, diabetologists, and many other medical specialists. T2DM has evolved from primarily medical disease into a condition where surgeons may play a more active role in the management of the diabetic patient. However, it has to be stressed that metabolic treatment of T2DM and other metabolic disorders need multidisciplinary approach and collaboration and that surgeon should play very important role as a multidisciplinary team member, however metabolic surgery should not yet be considered as stand-alone treatment modality.

• MeSH
• bariatrická chirurgie * metody   trendy   MeSH
• biologické modely MeSH
• diabetes mellitus 2. typu epidemiologie   metabolismus   chirurgie   MeSH
• gastrointestinální hormony sekrece   MeSH
• glukosa metabolismus   MeSH
• hmotnostní úbytek MeSH
• homeostáza MeSH
• inzulin sekrece   MeSH
• komorbidita MeSH
• lidé MeSH
• malabsorpční syndromy patofyziologie   MeSH
• mezioborová komunikace MeSH
• obezita ekonomika   epidemiologie   metabolismus   patofyziologie   chirurgie   MeSH
• osobní újma zaviněná nemocí MeSH
• postgastrektomické syndromy patofyziologie   MeSH
• tenké střevo sekrece   chirurgie   MeSH
• tuková tkáň metabolismus   MeSH
• týmová péče o pacienty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients. METHODS: Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss. RESULTS: Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved. CONCLUSIONS: Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.

• MeSH
• analýza rozptylu MeSH
• diabetes mellitus 2. typu krev   komplikace   patofyziologie   MeSH
• gastroplastika škodlivé účinky   metody   MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• laparoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• morbidní obezita krev   komplikace   patofyziologie   chirurgie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Type 2 diabetes mellitus (T2DM) resolution in morbidly obese patients following metabolic surgery suggests the efficacy of T2DM surgery in non-morbidly obese patients (body mass index [BMI] <35 kg/m(2)). This literature review examined research articles in English over the last 30 years (1979-2009) that addressed surgical resolution of T2DM in patients with a mean BMI <35. Weighted and simple means (95% CI) were calculated to analyze study outcomes. Sixteen studies met inclusion criteria; 343 patients underwent one of eight procedures with 6-216 months follow-up. Patients lost a clinically meaningful, not excessive, amount of weight (from BMI 29.4 to 24.2; -5.1), moving from the overweight into the normal weight category. There were 85.3% patients who were off T2DM medications with fasting plasma glucose approaching normal (105.2 mg/dL, -93.3), and normal glycated hemoglobin, 6% (-2.7). In subgroup comparison, BMI reduction and T2DM resolution were greatest following malabsorptive/restrictive procedures, and in the preoperatively mildly obese (30.0-35.0) vs overweight (25.0-25.9) BMI ranges. Complications were few with low operative mortality (0.29%). Novel and/or known mechanisms of T2DM resolution may be engaged by surgery at a BMI threshold

• MeSH
• bariatrická chirurgie metody   MeSH
• biliopankreatická diverze metody   MeSH
• diabetes mellitus 2. typu farmakoterapie   metabolismus   chirurgie   MeSH
• gastrektomie metody   MeSH
• gastroplastika metody   MeSH
• glykovaný hemoglobin analýza   MeSH
• hypoglykemika terapeutické užití   MeSH
• index tělesné hmotnosti MeSH
• krevní glukóza analýza   MeSH
• lidé MeSH
• žaludeční bypass metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• Publikační typ
• abstrakty MeSH

• MeSH
• bariatrická chirurgie kontraindikace   MeSH
• lidé MeSH
• morbidní obezita chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• konsensus - konference MeSH