Stephan C Bischoff1, Rocco Barazzoni2, Luca Busetto3, Marjo Campmans-Kuijpers4, Vincenzo Cardinale5, Irit Chermesh6, Ahad Eshraghian7, Haluk Tarik Kani8, Wafaa Khannoussi9,10, Laurence Lacaze11,12,13, Miguel Léon-Sanz14, Juan M Mendive15, Michael W Müller16, Johann Ockenga17, Frank Tacke18, Anders Thorell19,20, Darija Vranesic Bender21, Arved Weimann22, Cristina Cuerda23. 1. Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany. 2. Department of Medical, Technological and Translational Sciences, University of Trieste, Trieste, Italy. 3. Department of Medicine, University of Padova, Padova, Italy. 4. Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands. 5. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy. 6. Department of Gastroenterology, Rambam Health Care Campus, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel. 7. Department of Gastroenterology and Hepatology, Avicenna Hospital, Shiraz, Iran. 8. Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey. 9. Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco. 10. Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed the First University, Oujda, Morocco. 11. Department of Nutrition, Rennes Hospital, Rennes, France. 12. Department of general surgery, Mantes-la-Jolie Hospital, France. 13. Department of clinical nutrition, Paul Brousse-Hospital, Villejuif, France. 14. Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, Medical School, University Complutense, Madrid, Spain. 15. La Mina Primary Care Academic Health Centre. Catalan Institute of Health (ICS), University of Barcelona, Barcelona, Spain. 16. Department of General and Visceral Surgery, Regionale Kliniken Holding, Kliniken Ludwigsburg-Bietigheim gGmbH, Bietigheim-Bissingen, Germany. 17. Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen, Germany. 18. Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany. 19. Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden. 20. Department of Surgery, Ersta Hospital, Stockholm, Sweden. 21. Department of Internal Medicine, Unit of Clinical Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia. 22. Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany. 23. Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Abstract
BACKGROUND: Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE: The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS: The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS: In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION: The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
BACKGROUND: Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE: The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS: The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS: In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION: The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
Authors: Ho Cheol Hong; Soon Young Hwang; Hae Yoon Choi; Hye Jin Yoo; Ji A Seo; Sin Gon Kim; Nan Hee Kim; Sei Hyun Baik; Dong Seop Choi; Kyung Mook Choi Journal: Hepatology Date: 2014-03-24 Impact factor: 17.425
Authors: Pierre Singer; Annika Reintam Blaser; Mette M Berger; Waleed Alhazzani; Philip C Calder; Michael P Casaer; Michael Hiesmayr; Konstantin Mayer; Juan Carlos Montejo; Claude Pichard; Jean-Charles Preiser; Arthur R H van Zanten; Simon Oczkowski; Wojciech Szczeklik; Stephan C Bischoff Journal: Clin Nutr Date: 2018-09-29 Impact factor: 7.324
Authors: Stephan C Bischoff; Rocco Barazzoni; Luca Busetto; Marjo Campmans-Kuijpers; Vincenzo Cardinale; Irit Chermesh; Ahad Eshraghian; Haluk Tarik Kani; Wafaa Khannoussi; Laurence Lacaze; Miguel Léon-Sanz; Juan M Mendive; Michael W Müller; Johann Ockenga; Frank Tacke; Anders Thorell; Darija Vranesic Bender; Arved Weimann; Cristina Cuerda Journal: United European Gastroenterol J Date: 2022-08-12 Impact factor: 6.866