New research in the treatment of obesity

How would the whole world nor desperately struggled with obesity epidemic, the situation continues to deteriorate. According to the World Health Organization (WHO), with this diagnosis already live more 1,5 billion people, of them 500 million are obese IV degree, which at times increases the risk of diabetes, coronary disease, stroke and cancer. In the framework of the VI Congress of the South-Eastern European health forum, held in September 2015 the year in Odessa, innovation was presented, able to quickly solve the problem. And Ukrainian experts this has been an eye-opener.

Why can not?

It makes no sense to deny the obvious fact: problems with excess weight at most lie in the plane of psychotherapy. Unhealthy eating habits, which are transmitted from generation to generation, an abundance of fast food advertising, just pressing on the person from all sides, psychological feeling of "emptiness", creating a need to fill at least something, first meal,- it has long been studying the phenomenon. Sorry, to resolve the issue with the help of hours of conversations about the difficult childhood can not always. In our country, this approach is underdeveloped, although, According to the Ministry of Health (MH) Ukraine, 42% Of the population is obese. And even in the US, became a leader of the world of psychology, also has its own problems. Limiter in this case acts medical insurance, which can not cover the costly therapy without an absolute guarantee of results. Moreover, stage IV heart to heart conversation Obesity generally considered useless: here already need to act, and fast. Medical approach hardly justifies itself, the effect of short-term (most of all - while the person is taking medication). Lifestyle modification, although it seems the most logical and natural option, meets powerful resistance on the part of the patient, for whom this is too drastic changes. Exercise for a person with excess weight in general can pose a threat to health. It turns out, that almost any attempt to bring back the world's population to a normal body weight is doomed to failure. Nonetheless, US experts have found a way, which should help to overcome these problems.

hunger hormone

A new approach to the treatment of obesity is at the junction of endocrinology and cardiac surgery, and is a great example of the popular today, a multidisciplinary approach. The inspiration for the scientists was the high propensity of Americans to the operating methods of weight loss.
"Surgical treatment is indicated in patients with the highest degrees of obesity. If the overweight person is 5-15%, large abdominal surgery is not recommended, because the risk is greater than the expected benefits. Moreover, treatment often has a number of contraindications. At the same time, according to WHO, if you lose 5-10 kg of excess weight, forecast significantly reduced the risk of cardiovascular disease and improve a person on 52 other diseases, which is triggered by obesity indirectly development ",- said Nikoloz Kipshidze, doctor of medical sciences, Professor, Director of the US Center for Endovascular Therapy.

According to the Ministry of Health, 42% Of the population is obese

Decision, which offer American doctors, It is based on two apparently unrelated medical discoveries.
The first of these took place at the end of the last century, when scientists discovered the so-called hunger hormone - ghrelin. The inherent properties of the peptide hormone GnRH and other metabolic and endocrine functions. Ghrelin level was determined by radioimmunoassay. As it turned out, it increases before meals and decrease after them. Considered, ghrelin, leptin hormone supplements, which is produced in adipose tissue and in high concentrations it causes a feeling of fullness1. Studies have shown, that ghrelin levels in the blood plasma of patients with excess weight below, than people with normal body weight. Opposite, Anorexia patients have higher levels of ghrelin in the blood plasma compared to people of normal physique2. A study was conducted in patients with anorexia nervosa, which makes intravenous injection of ghrelin. As a result, the level of food consumption such patients has increased by 12-36% during the study period3. It proves, that ghrelin plays an important role in the mechanisms of formation of both anorexia, and obesity.

unnecessary artery

Ghrelin prohormone produced mainly P / D1-cells of fundic mucosa of the stomach. This fact links the "hungry" hormone with another scientific discovery. Specialists from the Medical College of Harvard University (Harvard Medical School) noticed, Most patients University Hospital, that urgent surgery for gastrointestinal bleeding was done, after discharge has been a steady decrease in weight4. During these operations usually performed embolization of the left gastric artery - this procedure leads to the cessation of the blood flow, However, gastric blood flow does not suffer, It remains as a sufficient number of blood vessels supplying blood to normal body, oxygenated. Moreover, It revealed, that thus decreases ghrelin secretion hormone. Generalizing this knowledge, the researchers concluded, that good results in the fight against obesity can be achieved, If "off" the left gastric artery.
The first experiments were carried out in pigs 2008 year. they proved, that the modification of blood circulation in the stomach really can achieve weight loss. And in 2013 Georgia, on the basis of clinics and the United States began to take research involving human subjects.

The movement of the touch

Six patients took part in the first study,. "It revealed, that the modification of blood circulation in the stomach helps to reduce appetite, but this method has a downside: inept actions can cause stomach ulcers. Among the six patients, in which the modification was made circulatory, gastric ulcer as a side effect was observed in two cases (33 %), gastritis - in six cases (100 %). We began to think about, how to make this method more secure. Worked on the problem several groups of scientists, and as a result, they concluded, you need to modify the artery, which are the submucosal layer of the stomach, and not in the mucous. The only way to prevent an ulcer or gastric tissue necrosis ",- shared experience of innovative procedures H. Kipšidze. According to him, experiments have shown, Nanoparticles custom size should be used to achieve a high safety profile during embolization.
"The four men and one woman overweight 35 kg were made surgery. They passed without complications, in spite of the fact, that the anatomy of the stomach is quite complicated, and get into the left gastric artery is not easy. The artery catheter, then via a syringe - nanoparticles, which are tiny balls of medical gelatin sized grit, allowing to create a plug-seal and block blood flow to the body of the stomach. The result is suppression of hormone ghrelin, and the person ceases to feel hunger ",- explained the methodology H. Kipšidze.

Studies have shown, that ghrelin levels in the blood plasma of patients with excess weight below,
than people with normal body weight

In the study, safety was defined as the absence of procedural complications, such as necrosis of the mucous membrane of the stomach in a week after the procedure and gastritis symptoms after one, three, six and 12 months. Proof of effectiveness were the statistically significant reduction in weight and a decrease in the level of ghrelin in the blood.
"We were looking for ways to improve the method, to avoid complications. We have developed a new robotic catheter system, which allows you to automatically enter it there microparticles, where you want, in the required amount. This allowed to make the procedure absolutely safe. Experiments have shown good results ",- said H. Kipšidze.
According to one of the founders of the methodology, Endoscopy was performed immediately before surgery and a week after her. Ghrelin level in the blood was measured by baseline for four weeks after the procedure. Weight decreased during the 30 days. Complications after surgery were not observed. Three of the five patients survived acute epigastric pain, but endoscopic control showed the presence of gastric ulcers or other abnormalities. A significant decrease in appetite, weight loss and suppression of ghrelin hormone were observed in all patients. One month after surgery the mean body mass index decreased, reached 37.9 kg / m2, reflecting an average weight loss of 13.15 kg. After 3 months mean body mass index was 36.7 kg / m2 (the total weight loss of 16.8 kg). Six months later, mean body mass index reached 35.3 kg / m2 (weight loss of 20.4 kg). Ghrelin levels fell by 29% compared to an initial level it within a month after surgery. Three months later, he was 36% below baseline, and six months fell 18% from baseline ((p) > 0,5).

News from the horse's mouth

N. Kipshidze stressed, that the main result of the study was to reduce the weight by an average of 16%. Moreover, patients were followed for two years after the embolization of the left gastric artery, and an increase in body weight or craving for food is not mentioned. So, it can be concluded that, that the long-term results are saved.
Total is now using a new minimally invasive procedure successfully treated 20 patients in various clinics around the world, and it gives hope for further effective treatment for certain categories of patients with obesity. Nonetheless, method requires deeper study involving a larger number of patients. Moreover, there are still unresolved issues. For example, Vascular gastric system is too complicated for existing devices, and need a new technical equipment, to fully perform embolization. In the future we plan to study the prospects of the procedure on the basis of Germany and Slovakia clinics.
For Ukraine, the new method is not yet available, because even in a number of US clinics level of technical equipment does not allow to carry out the procedure at a decent level. However, this example gives rise to find their own solutions, and expands the horizons of care to patients with a high degree of obesity. While it remains to follow the fate of the new approach and hope, that further its efficacy and safety are confirmed.

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