Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT Surgery

Weekly J ClubWeekly J Club

Supervised by:Supervised by:

Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani

Introduction:Introduction: Obesity is a well-known, chronic condition affects all ages.Obesity is a well-known, chronic condition affects all ages. The obesity epidemic has significant impact from social stigma to The obesity epidemic has significant impact from social stigma to

costly, comorbid diseases. costly, comorbid diseases. Gender differences exist between women & men as omen are more Gender differences exist between women & men as omen are more

likely:likely: (1) Dissatisfied with their weight.(1) Dissatisfied with their weight. (2) Dissatisfied with their body.(2) Dissatisfied with their body. (3) Associate body image with self-esteem.(3) Associate body image with self-esteem.

Epidemiology:Epidemiology: The prevalence is similar in women &men, with 1/3 adults being The prevalence is similar in women &men, with 1/3 adults being

obese.obese. Gender diff in the prevalence occur in certain subpopulations,non-Gender diff in the prevalence occur in certain subpopulations,non-

Hispanic African American women ,older women (age >60) Hispanic African American women ,older women (age >60) More severe forms of obesity affect women more than men.More severe forms of obesity affect women more than men.

GIT Diseases in obese women:GERDGIT Diseases in obese women:GERD Obesity is a known risk factor for GERD.Obesity is a known risk factor for GERD. Similar prevalence of symptomatic GERD in women & men.Similar prevalence of symptomatic GERD in women & men. GERD complications;erosive esophagitis,Barrett & EAC, are less GERD complications;erosive esophagitis,Barrett & EAC, are less

common in common in women.women. Central adiposity is less common in women than men, may explain Central adiposity is less common in women than men, may explain

the lower complications in women. the lower complications in women. Sex hormones implicated to explain different GERD manifestations. Sex hormones implicated to explain different GERD manifestations. Medical management, including behavioral modifications & acid Medical management, including behavioral modifications & acid

suppressive, is effective in ameliorating GERD symptoms. suppressive, is effective in ameliorating GERD symptoms. Weight loss resulting from surgical or diet/lifestyle interventions Weight loss resulting from surgical or diet/lifestyle interventions

can reduce or eliminate the symptoms of GERD:can reduce or eliminate the symptoms of GERD: (1) Dose-response relation between wt loss & symptoms (1) Dose-response relation between wt loss & symptoms

resolution.resolution. (2) Women derive benefit from smaller amounts of weight loss (2) Women derive benefit from smaller amounts of weight loss

than men (5%–10% vs >10% weight reduction).than men (5%–10% vs >10% weight reduction).

GIT Diseases in obese women:NAFLDGIT Diseases in obese women:NAFLD Strong correlations between NAFLD / obesity in women.Strong correlations between NAFLD / obesity in women. Prevalence of NAFLD is similar in women & men.Prevalence of NAFLD is similar in women & men. NAFLD is less common in premenopausal women versus age-NAFLD is less common in premenopausal women versus age-

matched men.matched men. Sex hormones are also linked to obesity / NAFLD. Sex hormones are also linked to obesity / NAFLD. Perimenopausal / postmenopausal women have lower estrogen & Perimenopausal / postmenopausal women have lower estrogen &

increased androgens, favors the development of the metabolic increased androgens, favors the development of the metabolic syndrome and NAFLD via increased visceral fat deposition.syndrome and NAFLD via increased visceral fat deposition.

The suggested protective effect of female sex hormonesThe suggested protective effect of female sex hormones (1) Alower prevalence of NAFLD in premenopausal women (1) Alower prevalence of NAFLD in premenopausal women

compared with men of the same agecompared with men of the same age (2) Women with NAFLD have significantly lower estradiol compared (2) Women with NAFLD have significantly lower estradiol compared

with those without NAFLD.with those without NAFLD. (3) Women >50 have a higher prevalence of NAFLD (3) Women >50 have a higher prevalence of NAFLD

GIT Diseases in obese women:NAFLDGIT Diseases in obese women:NAFLD Weight loss is typically recommended for obese patients with Weight loss is typically recommended for obese patients with

NAFLD; but effect on the natural history of the disease is unclear. NAFLD; but effect on the natural history of the disease is unclear. Modest weight loss of 5-10% or more can correct abnormal liver Modest weight loss of 5-10% or more can correct abnormal liver

chemistries&decrease liver size, fat content &steatohepatitis.chemistries&decrease liver size, fat content &steatohepatitis. Rapid weight loss after gastric bypass surgery, very-low-calorie Rapid weight loss after gastric bypass surgery, very-low-calorie

diets, or prolonged fasting,lowers hepatic fat content but can diets, or prolonged fasting,lowers hepatic fat content but can induce hepatic inflammation, worsening steatohepatitis,so slow, induce hepatic inflammation, worsening steatohepatitis,so slow, gradual weight loss is essential.gradual weight loss is essential.

NAFLD in women is also linked to DM, MS, low estrogen &elevated NAFLD in women is also linked to DM, MS, low estrogen &elevated androgen. androgen.

Premenopausal women have a lower prevalence of NAFLD, likely Premenopausal women have a lower prevalence of NAFLD, likely due to the protective effect of estrogen. due to the protective effect of estrogen.

Effective trt of NAFLD includes slow, gradual weight loss.Effective trt of NAFLD includes slow, gradual weight loss.

GIT Diseases in obese women:ObesityGIT Diseases in obese women:Obesity Obesity increase the prevalence of GSs in women specially in Obesity increase the prevalence of GSs in women specially in

child-bearing age.child-bearing age. Parity further increase the risk.Parity further increase the risk. HRT increase the risk.HRT increase the risk. Ocs (not low estrogen) increase the risk.Ocs (not low estrogen) increase the risk. URSO effective at preventing gallstone formation in URSO effective at preventing gallstone formation in obese women.obese women.