Considering that over 40% of U.S. adults have obesity and there are fewer than ten thousand obesity medicine specialists, PCPs are a critical part of the solution as we tackle this epidemic. While PCPs have extremely limited time to delve into the complexities of obesity and provide support between visits, it’s wonderful when they are knowledgeable about evidence-based obesity treatment so that they can at least initiate the conversation and refer their patients to an obesity specialist.

But the collaboration doesn’t stop there. Obesity is not only a chronic disease in its own right; it is also associated with more than 200 other conditions that can affect all body systems. According to data from IQVIA, people ages 40-64 with obesity have 2.4 comorbidities on average. That figure rises to 4.9 for individuals 65 and over (and 7% of people in the latter age group have 10 or more comorbidities). Effective treatment requires taking these comorbidities — and the medications often prescribed for them — into account and communicating with other members of the patient’s care team throughout treatment.

The following are just a few of the subspecialties that obesity touches.

• Cardiology: The impacts of obesity on cardiovascular health — raising the risk of high blood pressure, heart attack and stroke, among other conditions — are among the best known and most thoroughly studied. In fact, the anti-obesity medication, Wegovy, was recently approved specifically to reduce the risk of adverse cardiovascular events in individuals with obesity and established cardiovascular disease.

• Endocrinology: Adipose tissue is an active endocrine organ that produces more than a hundred different hormones, so it’s no surprise that endocrinologists are frequently involved in treating obesity-related conditions — Type 2 diabetes being the most familiar, but also polycystic ovarian syndrome and infertility, among many others.

• Orthopedics: Obesity is a risk factor for the development of soft tissue damage and osteoarthritis in load-bearing joints, particularly the knees, due to both inflammation and mechanical stress. Joint pain then inhibits physical activity, which worsens obesity, creating a vicious circle — while also increasing the risk of complications associated with orthopedic surgery.

• Oncology: Obesity is a risk factor for the development of many types of cancers, including breast, colon, rectal, pancreatic, kidney, esophagus, ovarian, skin, liver, thyroid, gallbladder, brain (meningioma) and endometrial cancer. Researchers believe that excess body fat leads to hormonal and metabolic changes that trigger inflammation and promote tumor growth.

• Gastroenterology: Obesity is associated with many digestive system diseases, including gastroesophageal reflux disease, esophagitis, gallstones, metabolic dysfunction-associated fatty liver disease and cirrhosis, and various related cancers.

• Pulmonology: Individuals with obesity face a higher risk of asthma, obstructive sleep apnea and other respiratory conditions (including, as we observed with COVID-19, potentially worse outcomes from viral infections).

• Psychiatry: Obesity and depression are closely linked, with a bidirectional association, and it’s worth noting that many antidepressants can promote weight gain, so prescribers should be prepared to consider weight-neutral or weight-loss-promoting alternatives for patients with obesity when possible. Other common mental health comorbidities include anxiety and eating disorders.

For many of these obesity-related health complications, losing weight can be the first line of treatment, and the relationship is often dose-dependent, meaning that these conditions worsen as obesity worsens and improve as obesity improves. This correlation may lead us to instinctively reach for GLP-1 medications as the most effective option, since we want to help our patients lose as much of their excess weight as possible and experience the greatest benefit. But especially considering significant cost, coverage and supply constriants, other anti-obesity medications can still bring measurable health benefits and might even be preferable for many individuals. Losing just 5% to 10% of body weight can lead to clinically significant improvements in markers such as blood glucose, cholesterol and blood pressure.

Improving patient health — not just reaching an arbitrary number on the scale — is the ultimate goal. Obesity touches everything, and treating obesity can have a positive, cascading effect on other conditions. If we can help a patient achieve Type 2 diabetes remission, reversal of sleep apnea or improved fertility, we’ll have made a real difference in their life.

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Why has your doctor requested this procedure?

Doctors use upper GI endoscopy to help diagnose and treat symptoms and conditions that affect the esophagus, stomach, and upper intestine or duodenum.

Upper GI endoscopy can help find the cause of unexplained symptoms, such as

• persistent heartburn
• bleeding
• nausea and vomiting
• pain
• problems swallowing
• unexplained weight loss

Upper GI endoscopy can be used to identify many different diseases:

• gastroesophageal reflux disease
• ulcers
• cancer
• inflammation, or swelling
• precancerous abnormalities such as Barrett’s esophagus
• celiac disease
• strictures or narrowing of the esophagus
• blockages

Upper GI endoscopy can check for damage after a person eats or drinks harmful chemicals.

During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece of tissue for testing. Biopsies are needed to diagnose conditions such as

• cancer
• celiac disease
• gastritis

Doctors also use upper GI endoscopy to

• treat conditions such as bleeding from ulcers, esophageal varices, or other conditions
• dilate or open up strictures with a small balloon passed through the endoscope
• remove objects, including food, that may be stuck in the upper GI tract
• remove polyps or other growths
• place feeding tubes or drainage tubes

Doctors are also starting to use upper GI endoscopy to perform weight loss procedures for some people with obesity.

What happens during the procedure?

A doctor performs an upper GI endoscopy in a hospital or an outpatient center. Before the procedure, you will likely get a sedative or a medicine to help you stay relaxed and comfortable during the procedure. The sedative will be given to you through an intravenous (IV) needle in your arm. In some cases, the procedure can be done without getting a sedative. You may also be given a liquid medicine to gargle or a spray to numb your throat and help prevent you from gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible.

You’ll be asked to lie on your side on an exam table. The doctor will carefully pass the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During the upper GI endoscopy, the doctor may

• take small samples of tissue, cells, or fluid in your upper GI tract for testing.
• stop any bleeding.
• perform other procedures, such as opening up strictures.

The procedure is quick and usually takes between 15 and 30 minutes. The endoscope does not interfere with your breathing, and many people fall asleep during the procedure.

What do you need to do?

You should talk with your doctor about your medical history, including medical conditions and symptoms you have, allergies, and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

• aspirin or medicines that contain aspirin
• arthritis medicines 
• blood thinners
• blood pressure medicines
• diabetes medicines
• nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen 

You can take most medicines as usual, but you may need to adjust or stop some medicines for a short time before your upper GI endoscopy. Your doctor will tell you about any necessary changes to your medicines before the procedure.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after the procedure, as the sedatives used during the procedure need time to wear off. You will need to make plans for getting a ride home after the procedure.

Do not eat or drink before the procedure

To see your upper GI tract clearly, your doctor will most likely ask you not to eat or drink up to 8 hours before the procedure.

Are there risks to the procedure?

Upper GI endoscopy is considered a safe procedure. The risks of complications from an upper GI endoscopy are low, but may include

• bleeding from the site where the doctor took the tissue samples or removed a polyp
• perforation in the lining of your upper GI tract
• an abnormal reaction to the sedative, including breathing or heart problems

Bleeding caused by the procedure often is minor and stops without treatment. Serious complications such as perforation are uncommon. Your doctor may need to perform surgery to treat some complications. Your doctor can also treat an abnormal reaction to a sedative with medicines or IV fluids during or after the procedure.

• chest pain
• problems breathing
• problems swallowing or throat pain that gets worse
• vomiting—particularly if your vomit is bloody or looks like coffee grounds
• pain in your abdomen that gets worse
• bloody or black, tar-colored stool
• fever

The post Upper Gastrointestinal (GI) Endoscopy appeared first on Medika Life.

Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum. Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.

Why has your doctor requested this test?

Doctors use ERCP to treat problems of the bile and pancreatic ducts. Doctors also use ERCP to diagnose problems of the bile and pancreatic ducts if they expect to treat problems during the procedure. For diagnosis alone, doctors may use noninvasive tests—tests that do not physically enter the body—instead of ERCP.

Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of

• gallstones that form in your gallbladder and become stuck in your common bile duct
• infection
• acute pancreatitis
• chronic pancreatitis
• trauma or surgical complications in your bile or pancreatic ducts
• pancreatic pseudocysts 
• tumors or cancers of the bile ducts 
• tumors or cancers of the pancreas 

What happens during the procedure?

Doctors who have specialized training in ERCP perform this procedure at a hospital or an outpatient center. An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. A health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat. The anesthetic numbs your throat and helps prevent gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible. In some cases, you may receive general anesthesia.

You’ll be asked to lie on an examination table. The doctor will carefully feed the endoscope down your esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During ERCP, the doctor

• locates the opening where the bile and pancreatic ducts empty into the duodenum
• slides a thin, flexible tube called a catheter through the endoscope and into the ducts
• injects a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible on x-rays
• uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages

The doctor may pass tiny tools through the endoscope to

• open blocked or narrowed ducts.
• break up or remove stones.
• perform a biopsy or remove tumors in the ducts.
• insert stents—tiny tubes that a doctor leaves in narrowed ducts to hold them open. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.

The procedure usually takes between 1 and 2 hours.

What do you need to do?

You should talk with your doctor about any allergies and medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

• arthritis medicines 
• aspirin or medicines that contain aspirin
• blood thinners 
• blood pressure medicines 
• diabetes medicines
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Your doctor may ask you to temporarily stop taking medicines that affect blood clotting or interact with sedatives. You typically receive sedatives during ERCP to help you relax and stay comfortable.

Tell your doctor if you are, or may be, pregnant. If you are pregnant and need ERCP to treat a problem, the doctor performing the procedure may make changes to protect the fetus from x-rays. Research has found that ERCP is generally safe during pregnancy.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after ERCP, as the sedatives or anesthesia used during the procedure needs time to wear off. You will need to make plans for getting a ride home after ERCP.

Don’t eat, drink, smoke, or chew gum

To see your upper GI tract clearly, you doctor will most likely ask you not to eat, drink, smoke, or chew gum during the 8 hours before ERCP.

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