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The effect of reduced frequency of administration of misoprostol on its ability to prevent aspirin-induced gastric injury was evaluated. Twenty-four random-source dogs were divided into 4 groups which received aspirin and misoprostol as follows: Group I, 25 mg/kg aspirin PO TID and placebo PO TID; Group II, 25 mg/kg aspirin PO TID and misoprostol 3 ug/kg PO TID; Group III, 25 mg/kg aspirin PO TID, misoprostol 3 ug/kg PO BID and placebo PO QD; and Group IV, 25 mg/kg aspirin PO TID, misoprostol 3 ug/kg PO QD and placebo PO BID for 28 days. Groups were stratified to contain an equal number of dogs positive or negative for Helicobacter spp. based on results of ‘CLO test’. Gastroscopy was performed on days –9, 5, 14 and 28. Each region of the stomach was evaluated separately and visible lesions were scored on a scale of 1 (submucosal hemorrhage) to 11 (perforating ulcer). The scores for each region were summed and the median total score for each group at each day and median total score within each group between days was compared using a Kruskal-Wallis test. No difference in total score was identified between Group I and IV on any day. Median total scores for Groups II and III were significantly(p < 0.05) lower compared to Groups I and IV on day 5. Significant difference was observed on Day 14 between the total score of Group III and Group IV. Group III had a significantly lower score (p < 0.05) than Groups I, II and IV on day 28. Gastric erosions were present in all groups in the study. This study suggests that misoprostol 3 ug/kg PO BID dosing is as effective as misoprostol 3 ug/kg PO TID dosing at preventing aspirin-induced gastric injury in this model. However, misoprostol 3 ug/kg PO TID dosing was less effective in preventing aspirin-induced gastric injury on days 14 and 28 than in previous studies. The lack of efficacy of TID dosing on days 14 and 28 may be related to higher salicylate concentrations in Group II dogs or individual variation within the small study population. / Master of Science

This study tested the hypothesis that administration of immunosuppressive doses of prednisone in conjunction with ultralow-dose aspirin (0.5 mg/kg/day) would result in gastroduodenal lesion scores similar to those found in dogs administered only immunosuppressive doses of prednisone, but that the gastroduodenal scores from both of these treatment groups would be significantly higher than placebo when administered to healthy dogs for 27 days. Eighteen healthy adult purpose-bred dogs were divided randomly into three groups. Group I received placebo capsules and placebo suspension, Group II received prednisone capsules (mean 2.3 mg/kg, range 2.0-2.4) and placebo suspension, and Group III received prednisone capsules (mean 2.3 mg/kg, range 2.3-2.5) and aspirin suspension (0.5 mg/kg) by mouth once daily for 27 days. Gastroduodenoscopy was performed on days -7 (baseline), 5, 14, and 27 of treatment. Four regions of the stomach (angularis incisura, body, pylorus, and cardia) and the proximal descending duodenum were systematically scored on a scale of 1 (normal) to 11 (perforating ulcer) by an experienced observer who was blinded to the treatment groups and clinical signs of each subject. Dogs were observed every 8 hours for vomiting, diarrhea, and inappetence. Feces were scored on a scale of 1-5 with diarrhea defined as a fecal score <4. Lesion scores for each group, at each location, and total scores, at each time period were evaluated for the effects of time and treatment using a Kruskal-Wallis test. Total dog days of vomiting and dog days of diarrhea in each group were compared using a Wilcoxon rank sums test. Significance was determined at p<0.05. There were no significant differences in median total gastric lesion scores between any of the groups at any time during the study. There was no location effect on regional gastroduodenal lesion scores and there was no significant change in gastroduodenal lesion scores over time in any of the groups during treatment. Significantly more dog-days of diarrhea occurred within the prednisone and aspirin group during the experimental period (Period 2) in comparison to Period 1. However, no significant differences were found between any of the groups for dog-days of vomiting, diarrhea or inappetence at any time in the study. / Master of Science

Bakgrund: Fetma och övervikt har blivit vanligare den senaste tiden och är idag ett stort hälsoproblem över hela världen. Många har svårt att gå ner i vikt på egen hand vilket har gjort att kirurgi har blivit allt vanligare de senaste åren. Gastric bypass är idag den vanligaste kirurgiska metoden för viktminskning och har visat goda resultat. Däremot kan den hälsorelaterade livskvalitén påverkas då operationen innebär en stor livsstilsförändring. Syfte: Syftet med denna studie var att beskriva vuxna personers upplevelse av hälsorelaterad livskvalité efter en gastric bypass operation. Metod: En litteraturöversikt med 11 kvantitativa och 3 kvalitativa vetenskapliga artiklar som ligger till grund för hur vuxna personer upplever sin hälsorelaterade livskvalité efter en gastric bypass operation. Resultat: Hälsorelaterad livskvalité (HRQOL) har visat en förbättring i samtliga studier efter en gastric bypass operation. HRQOL har haft sin topp efter 1 månad i samtliga skalor utifrån SF-36 frågeformulär. Slutsats: Den stora livsstilsförändringen som personer går igenom efter en gastric bypass operationen har visat förbättringar i HRQOL på både lång och kort sikt. Bidragande faktorer som kan påverka den förbättrade hälsorelaterade livskvalitén kan bland annat vara uppfyllda förväntningar av operationen och fysisk aktivitet. / Background: Obesity and overweight have become more frequent in recent years and is today a major health problem worldwide. A lot of people find it difficult to lose weight on their own which has made surgery become more common in recent years. Gastric bypass surgery is currently the most common surgical method of weight loss and have shown good results. However, the health-related quality of life is affected as the operation demand a major lifestyle change. Purpose: The purpose of this study was to describe adults’ experience of health-related quality of life after a gastric bypass surgery. Method: The study contains 11 quantitative and 3 qualitative scientific articles describing the adults’ experience of health-related quality of life after a gastric bypass surgery. Results: Health-related quality of life (HRQOL) has shown an improvement in all studies after a gastric bypass surgery. HRQOL has had its peak after 1 month in all scales based on the SF-36 questionnaire. Conclusion: The major lifestyle change that people go through after a gastric bypass surgery has shown improvements in HRQOL in both long and short term. Contributing factors that may affect the improved health-related quality of life can among other things be fulfilled expectations of the surgery and physical activity.

Studien syftar till att belysa gastric by-pass opererade personers upplevelser före och efter operationen. Studien är utformad efter en fenomenologisk ansats och fokus ligger mot fenomenet som är upplevelserna av en gastric by-pass. De medverkande avgränsades till kvinnor och ett inklusionskriterium för att medverka i studien var att de hade genomgått en gastric bypass operation. Datainsamlingen skedde med hjälp av kvalitativa intervjuer. Vi har eftersträvat att få våra intervjuer till ett samtal, där vi som intervjuar är aktiva lyssnare. Bearbetningen av materialet fokuserade på de teman vi fann; Socialt isolerad och rädslan för varaktiga relationer, förväntningar och en svårighet att se skillnad, smärta och värk- operationen som en sista utväg, vården och komplikationer, jag ångrar mig inte och jag är lyckligare idag, den sociala omgivningen samt kroppslig förändring. Studiens resultat visar att det finns upplevelser av en gastric by-pass operation som har inverkan på den psykosociala hälsan. Med stöd av resultatet kan vi dra slutsatsen om att en gastric by-pass operation bidrar till att kvinnorna anser att dem lever ett lyckligare liv. Kvinnorna lever ett lyckligare liv bland annat eftersom dem har en känsla av att passa in i samhället, men operationen kan bidra till en del fysiska komplikationer, som kvinnorna redogör för. / The study aims to highlight the gastric bypass surgery people's experiences before and after surgery. The study is designed with a phenomenological approach and our focus is on our phenomenon, the experience of a gastric by-pass. The participants were limited to women and an inclusion criterion to participate in the study was that they had undergone a gastric by-pass operation. Data collection was done using qualitative interviews. We have strived to make our interviews to a conversation where we are active listeners. The processing of the material focused on the themes we found; Socially isolated and the fear of relationships, expectations and an inability to see the difference, pain and surgery as a last resort, treatment and complications, I don’t regret it and I'm happier today, the social environment and physical change of body. We have found that there are experiences of a gastric by-pass surgery that have impact on the psychosocial health. With the support of the results we can conclude that gastric by-pass surgery helps participants live a happier life with a feeling of fitting into the society, but that the surgery may contribute to complications that woman in the study are telling us about.

Η λαπαροσκοπική γαστρική παράκαμψη κατά Roux-en-Y είναι μία από τις πιο ευρέως χρησιμοποιούμενες βαριατρικές επεμβάσεις για την αντιμετώπιση της νοσογόνου παχυσαρκίας. Η απώλεια βάρους μετά από βαριατρικού τύπου επεμβάσεις έχει συσχετισθεί με τις επερχόμενες μεταβολές των γαστρεντερικών ορμονών, που έχει δειχθεί ότι συνδέονται με τον έλεγχο του μεταβολισμού και της όρεξης. Σκοπός: Η μελέτη της επίδρασης της εκτομής του θόλου του στομάχου σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη στην έκκριση των ορμονών, τα επίπεδα της γλυκόζης αλλά και την απώλεια βάρους. Μέθοδος: Δώδεκα ασθενείς υποβλήθηκαν σε λαπαροσκοπική γαστρική παράκαμψη και δώδεκα σε λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου του στομάχου. Όλοι οι ασθενείς μελετήθηκαν προοπτικά πρίν και τρείς, έξι και δώδεκα μήνες μετά την επέμβαση. Η συλλογή των δειγμάτων έγινε μετά από δωδεκάωρη νηστεία και 30, 60 και 120 λεπτά μετά την χορήγηση πρότυπου γεύματος θερμιδικού φορτίου 300 Kcal. Αποτελέσματα: Το σωματικό βάρος και ο δείκτης μάζας σώματος μειώθηκαν σημαντικά (p<0.001) και στις δύο ομάδες χωρίς όμως διαφορές μεταξύ των ομάδων. Για την ομάδα της γαστρικής παράκαμψης τα επίπεδα γκρελίνης νηστείας μειώθηκαν στους τρείς μήνες μετεγχειρητικά και αυξήθηκαν στούς δώδεκα μήνες σε επίπεδα υψηλότερα σε σχέση με τα προεγχειρητικά (p<0.01), αντίθετα, μετά από λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου, τα επίπεδα γκρελίνης νηστείας μειώθηκαν σημαντικά και παρέμειναν χαμηλά σε όλες τις χρονικές στιγμές της μελέτης (p<0.01). H μεταγευματική απόκριση του PYY, του GLP-1 και της ινσουλίνης ενισχύθηκαν μετεγχειρητικά (p<0.01) και στις δύο επεμβάσεις αλλά η απόκριση ήταν σημαντικά μεγαλύτερη και τα μεταγευματικά σάκχαρα χαμηλότερα μετά από γαστρική παράκαμψη και εκτομή του θόλου του στομάχου (p for interaction <0.05). Μετεγχειρητικά οι μεταβολές της γκρελίνης συσχετίστηκαν αρνητικά με τις μεταβολές του GLP-1. Συμπεράσματα: Η εκτομή του θόλου του στομάχου σε ασθενείς που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη οδηγεί σε χαμηλότερα βασικά επίπεδα γκρελίνης, σε μεγαλύτερη μεταγευματική απόκριση GLP-1, PYY και ινσουλίνης και σε χαμηλότερα σάκχαρα σε σχέση με την λαπαροσκοπική γαστρική παράκαμψη. Η εκτομή του θόλου του στομάχου με συνοδό γαστρική παράκαψη μπορεί να αποδειχθεί μια πολύ χρήσιμη καινούργια χειρουργική τεχνική για την αντιμετώπιση της νοσογόνου παχυσαρκίας και του σακχαρώδη διαβήτη τύπου ΙΙ. / Background: Laparoscopic Roux-en Y-Gastric bypass (LRYGBP) is the commonest available option for the surgical treatment of morbid obesity. Weight loss following bariatric surgery has been linked to changes of gastrointestinal peptides, shown to be implicated also in metabolic effects and appetite control. The purpose of this study was to evaluate whether gastric fundus resection in patients undergoing LRYGBP enhances the efficacy of the procedure in terms of weight loss, glucose levels and hormonal secretion. Methods: 12 patients underwent LRYGBP and 12 patients LRYGBP plus gastric fundus resection (LRYGBP+FR). All patients were evaluated before and at 3, 6, and 12 months postoperatively. Blood samples were collected after an overnight fast and 30, 60 and 120 min after a standard 300 kcal mixed meal. Results: Body weight and body mass index decreased markedly and comparably after both procedures. Fasting ghrelin decreased three months after LRYGBP, but increased at 12 months to levels higher than baseline while after LRYGBP+FR was markedly and persistently decreased. Postprandial GLP-1, PYY and insulin responses were enhanced more and postprandial glucose levels were lower after LRYGBP+FR compared to LRYGBP. Postoperatively, ghrelin changes correlated negatively with GLP-1 changes. Conclusions: Resection of the gastric fundus in patients undergoing LRYGBP was associated with persistently lower fasting ghrelin levels, higher postprandial PYY, GLP-1 and insulin responses and lower postprandial glucose levels compared to LRYGBP. These findings suggest that fundus resection in the setting of LRYGBP may be more effective than RYGBP for the management of morbid obesity and diabetes type 2.

Bakgrund: De senaste tjugo åren har förekomsten av fetma fördubblats i världen och räknas därför till en global epidemi och är ett stort folkhälsoproblem. I samband med detta har även det kirurgiska ingreppet gastric bypass blivit allt vanligare. Det är därför viktigt att sjuksköterskor och personer som överväger denna operation får en ökad förståelse och kunskap om hur patienter som genomgått operationen upplever livet efter. Syfte: syftet med denna studie var att beskriva kvinnors upplevelser efter en gastric bypass operation. Metod: I studien användes kvalitativ ansats för att studera bloggar skrivna av kvinnor som genomgått en gastric bypass operation. Fjorton Bloggar analyserades. Resultat/ Diskussion: Resultatet visar att kvinnorna får en bättre livskvalité då de har lättare att röra på sig och inte längre upplever obehag när de deltar i sociala sammanhang. Dock finns en baksida med operationen, de har svårt att ställa om till den nya livsstilen som är ett måste för att undvika komplikationer. Många av kvinnorna upplever också identitetskriser. Slutsats: Det är av stor vikt att patienter som genomgår gastric bypass operation får hjälp med förhållningssätt och information kring kosthållning för att kunna få en hälsosam och bestående viktminskning och livsstil. Vidare forskning om hur kvinnorna mår psykiskt innan respektive efter operationen behöver göras då fler människor väljer denna viktminskningsmetod. / Background: The worldwide prevalence of obesity has doubled in the last twenty years and is therefore classified as a global epidemic and is therefore a major health problem. This has initiated the gastric bypass surgery to increase. It is therefore important that nurses and people considering this operation have a better understanding and knowledge the life after the surgery. Objective: The aim of this study was to describe women's experiences after a gastric bypass surgery. Method: This study used qualitative method to study the blogs written by women who have gone through gastric bypass surgery. It contains 14 analysed blogs. Results/ Discussion: The result shows that women have a better quality of life when it´s easier for them to move around and don’t feel the discomfort when they are participating in social activities. However, there is a downside to the surgery. They find it difficult to adjust to the new lifestyle, in order to avoid the complications. Some of these women are also experiencing identity crisis. Conclusion: It is therefore significant for patients who have gone through gastric bypass surgery to get the support they need with attitudes and information about diet to have a healthy and permanent weight loss and lifestyle. Further research on how women experience the psychological health before and after the surgery needs to be done since obesity is increasing and more people are choosing this method for weight loss.

Bakgrund: Övervikt och fetma är ett folkhälsoproblem i Sverige och har ökat kraftigt de senaste decennierna. Fetmakirurgi i allmänhet och gastric bypass (GBP) i synnerhet är effektiva sätt att gå ner i vikt när traditionella metoder inte hjälper. Det är väl känt att den fysiska dimensionen av livskvaliteten förbättras efter operationen men den psykiska dimensionen är mer oklar. Syfte: Att undersöka hur den psykiska hälsan påverkas hos vuxna personer som genomgått GBP. Metod: En litteraturöversikt gjordes efter sökningar i databaserna PubMed och CINAHL. 14 artiklar med kvalitativ eller kvantitativ design valdes ut. Resultat: Hälften av artiklarna visade på minskad depression och ångest efter operationen. Samtliga artiklar som undersökte självmord och självskadebeteende hittade en ökning postoperativt. Två av sju artiklar visade på förbättringar i Mental Component Summary (MCS) enligt frågeformuläret SF-36 efter operationen. För mental hälsa visade fem artiklar statistiskt signifikanta förbättringar efter operationen. Alla kvalitativa artiklar visade på en stor förändring i det dagliga livet efter operationen. Förändringen kunde uttrycka sig både positivt och negativt. Till exempel kunde de positiva upplevelserna vara en känsla av ett nytt liv. De negativa upplevelserna som kunde förekomma var överskottshud, dumping-syndrom samt diskrepans i kroppsuppfattningen. Slutsats: Sammanfattningsvis har detta arbete kommit fram till att det saknas ett entydigt svar på hur den psykiska hälsan påverkas av GBP. / Background: Obesity is a public health issue that has been increasing in Sweden the last few decades. Bariatric surgery and gastric bypass (GBP) in particular are effective in achieving weight loss and is growing in numbers. It is well known that gastric bypass has a positive influence on the physical domain of the quality of life. However, the effect that gastric bypass has on the mental health remains uncertain. Aim: To investigate how the mental health is affected in adults that undergo GBP. Method: A literature review was made after searches in databases PubMed and CINAHL. 14 articles with qualitative and quantitative design were chosen. Results: Half of the articles showed a decrease in depression and anxiety after surgery. All of the articles investigating suicide and self-harm found a postoperative increase. Two out of seven articles showed improvement in the Mental Component Summary (MCS) according to the questionnaire SF-36 after surgery. As for mental health, five out of six articles showed a significant improvement after surgery. All of the qualitative data proved great differences in daily life. These changes were both positive and negative, where the positive changes were a feeling of a new life. The negative changes were excess skin folds, dumping syndrome and a discrepancy in body image.  Conclusions: In conclusion, this essay states that there is no substantial evidence on how mental health is affected by GBP.

Gastric banding as a weight loss surgery has increased in popularity in the United States since its approval by the Food and Drug Administration in 2001. Successful weight loss after weight loss surgery is most frequently defined as greater than 50 percent of excess weight loss (EWL). Systematic reviews show that the band is widely effective in achieving successful weight loss in most patients, however individual studies show more inconsistent outcomes. Although previous research supports gastric bypass surgery as having a positive effect on quality of life after gastric bypass, there is very little data to support this relationship in gastric banding patients. Weight loss outcomes after gastric banding surgery at Virginia Commonwealth Health System were less than 50 per cent EWL at one and two years. A retrospective, descriptive study sought to answer the following questions: 1) What is the relationship between physical activity, eating behaviors and hunger control on weight loss and quality of life after gastric banding surgery and 2) Does successful weight loss at one year predict successful weight loss at two years. The International Physical Activity Questionnaire Sort Form (IPAQ) was used to assess participation in physical activity. The Medical Outcomes Study Short Form (SF-36) was used to determine quality of life. Weight loss outcomes were 34.6 per cent at one year and 39.7 per cent at two years, which was less than the established success rate of greater than 50 per cent EWL, However, most patients lost some weight and demonstrated a significant improvement in most domains of health related quality of life. Participation in physical activity increased fro preoperatively to year one but decreased in year two. Although participation in physical activities overall decreased from year one to year two, there was a significant relationship between participation in greater than 150 minutes per week of moderate or vigorous physical activity and adequate weight loss (p =0.025) and participation in health enhancing physical activities and adequate weight loss (p < 0.05). There was no statistically significant relationship noted between any of these eating behaviors and the percentage of excess weight loss at one or two years. There was a significant relationship between degree of hunger reported by patients and successful weight loss at one year (p < 0.05). There is sufficient statistical evidence of a positive linear relationship between two- year weight loss and one- year weight loss (p < 0.05). That is, one-year weight loss is a significant predictor for two- year weight loss. Based on the results of this study, it is recommended that gastric banding patients participate in at least 150 minutes per week of moderate to vigorous physical activity. Additionally, clinicians should consider development of adjustment protocols that achieve early reduction of hunger in the banding patient.

The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery. The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI&gt;48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results. Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH&lt;4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p&lt;0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus. This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI&gt;48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.