A case of severe anorexia, excessive weight loss and high peptide YY levels after sleeve gastrectomy

[摘要] Sleeve gastrectomy (SG) is the second most commonly performed bariatric procedure worldwide. Altered circulating guthormones have been suggested to contribute post-operatively to appetite suppression, decreased caloric intake and weightreduction. In the present study, we report a 22-year-old woman who underwent laparoscopic SG for obesity (BMI 46 kg/m2).Post-operatively, she reported marked appetite reduction, which resulted in excessive weight loss (1-year post-SG: BMI22 kg/m2, weight loss 52%, O99th centile of 1-year percentage of weight loss from 453 SG patients). Gastrointestinal (GI)imaging, GI physiology/motility studies and endoscopy revealed no anatomical cause for her symptoms, and psychologicalassessments excluded an eating disorder. Despite nutritional supplements and anti-emetics, her weight loss continued(BMI 19 kg/m2), and she required nasogastric feeding. A random gut hormone assessment revealed high plasma peptideYY (PYY) levels. She underwent a 3 h meal study following an overnight fast to assess her subjective appetite and circulatinggut hormone levels. Her fasted nausea scores were high, with low hunger, and these worsened with nutrient ingestion.Compared to ten other post-SG female patients, her fasted circulating PYY and nutrient-stimulated PYY and activeglucagon-like peptide 1 (GLP1) levels were markedly elevated. Octreotide treatment was associated with suppressedcirculating PYY and GLP1 levels, increased appetite, increased caloric intake and weight gain (BMI 22 kg/m2 after 6 months).The present case highlights the value of measuring gut hormones in patients following bariatric surgery who present withanorexia and excessive weight loss and suggests that octreotide treatment can produce symptomatic relief and weight regainin this setting.

[学科分类] 血液学

[关键词] Adult;Female;White;United Kingdom;Stomach;Peptide YY;Obesity;Iatrogenic disorder;Nausea;Anorexia;Weight loss;BMI;Insulin;Glucose (blood);Total ghrelin;Acyl-ghrelin;GLP-1;Bariatric surgery;Gastrectomy;Octreotide;Gastroenterology;General practice;Psychology/Psychiatry;New disease or syndrome: presentations/diagnosis/management;June;2015