2016-04-01

Obesity and Gastrointestinal Diseases

Dr. Kevin LIU - Council Member, HKOS

Obesity is increasing at an alarming rate worldwide. Obesity can affect every single organ along the alimentary tract, causing ill health of the patients. It increases the risk of developing gastroesophageal reflux disease, Barrett’s esophagus, erosive esophagitis, non-alcoholic fatty liver disease, gallstones, pancreatitis and colorectal polyps. Apart from the relatively benign digestive diseases, obesity also increases the risk of developing oesophageal adenocarcinoma, gastric cardia adenocarcinoma, cholangiocarcinoma, pancreatic cancer, hepatocellular carcinoma and colorectal cancer. The increased rate of gastrointestinal tract cancers may be related to the increased insulin like growth factor (IGF-1) as a result of insulin resistance and increased insulin-like growth factor-binding proteins.

At present, bariatric surgery is employed as the mainstay to treat morbid obesity. However, it has low patients’ acceptance rate with less than 2% of eligible patients underwent surgery. In recent years, several endoscopic devices were developed to treat obesity. Endoscopic bariatric surgery is less invasive compared to the traditional bariatric surgery and may be more appealing to the patients. It can be broadly be divided into 6 main categories: 1) space-occupying devices (e.g. intragastric balloons); 2) restrictive procedures (e.g. endoscopic gastroplasty); 3) bypass liners (e.g. gastroduodenojejunal bypass liner); 4) electrical stimulation; 4) aspiration therapy and 5) others (e.g. duodenal mucosal resurfacing). So far only 2 types of intragastric balloons and an aspiration devices were approved by US Food and Drug Administration (FDA) were approved for the endoscopic treatment of obesity. A variety of devices were being developed and tested in clinical trials.

Although bariatric surgery and endoscopic devices are effective in treating obesity, patients can only achieve maximal benefits through a multidisciplinary approach. With the establishment of the Hong Kong Obesity Society, we hope to raise public awareness of the increasing obesity problem and to provide the latest obesity management news for doctors and allied health professionals.