Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
BMC Geriatr. 2021 Nov 4;21(1):631. doi: 10.1186/s12877-021-02578-z.
In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications.
A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning.
Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.
在 70 年代中期，胆胰分流术作为减肥手术变得流行。这种减重手术结合了远端胃切除术和肠道吸收不良，导致比其他减重手术更大的体重减轻和改善合并症。如今，由于营养并发症的风险较高，胆胰分流术已变得过时。然而，目前接受胆胰分流术的患者正在老龄化。因此，老年病医生和全科医生会更频繁地遇到他们，并面临晚期并发症的后果。
一名 74 岁女性出现乏力、反复跌倒、意识混乱、反应迟钝、厌食和体重减轻。她的病史包括骨质疏松症、8 年前的疱疹性脑炎和 52 岁时的胆胰分流术（Scopinaro 手术）。脑部影像学显示疱疹后遗症无明显萎缩。诊断为代谢性营养不良性谵妄。生化筛查显示维生素 A 缺乏、维生素 E 缺乏、锌缺乏和严重低白蛋白血症。而硫胺素水平和空腹血糖正常。然而，观察到餐后高胰岛素血症性低血糖，伴有意识混乱和意识模糊的迹象。开始肠外营养并补充额外的微量营养素后，认知和身体功能明显改善。
胆胰分流术对老年患者的长期影响相对报道较少。然而，胃肠道的解剖和生理变化可能导致代谢和营养并发症的发展，最终导致认知障碍、功能下降和谵妄。因此，有必要评估老年胆胰分流术后患者是否存在代谢紊乱和营养并发症。
