I have seen a lot of back and forth recently with questions about bariatric surgery and, in particular, what to do with these patients. This Computer Consult is meant to tell care providers, regardless of specialty, to be on alert for nutritional deficiency. Especially when somebody tells you that they have had previous bariatric surgery.
This is now one of the most commonly performed surgeries, not only in the United States but also emerging worldwide. This is due to the obesity epidemic and the significant improvement that we see not only in weight reduction but also in the metabolic consequences, such as diabetes, hyperlipidemia, and cardiovascular risks, and even cancer risk.
In my experience, one of the things that does not happen commonly enough is the routine monitoring of these patients. The Centers for Medicare & Medicaid Services now requires you to perform this operation to be a recognized Center of Excellence, and there are certain criteria that equate to this. There are many patients who have had these bariatric procedures who may perhaps just land in your lap. You really need to understand that these patients need to be watched routinely.
I have been privileged enough to edit two issues of Gastroenterology Clinics in North America in 2005 and 2010, which included work on bariatric surgery. In doing so, I have learned a lot from a lot of smart people, and want to highlight some of the things that are really critical for you to know when you see these patients in your practice.
First, there clearly are elements of macronutrient deficiency. This is protein malnutrition. The worst case is those patients who come in with severe protein malnutrition.
It is important to recognize that the protein malnutrition is maybe a consequence of how they are eating, but also depends on what type of surgery they have had. The more extensive surgeries, such as biliary-pancreatic diversion surgery or more extended Roux-en-Y gastric bypass surgery, may result in more protein malabsorption. You can also see this with bacterial overgrowth.
Routine monitoring of albumin in these patients is pretty reasonable, but prealbumin is probably a better short-term assessment here and more variable in response to interventional nutritional efforts.
You can read more about different vitamin deficiencies on Med Scape here: http://wb.md/2no04cp