Browsing by Author "Shah, Raj A."

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    Impact of Obesity Subtypes on Short-Term Weight Loss Following Vertical Sleeve Gastrectomy
    Shah, Raj A.; Nath, Anand; Shope, Timothy R.; Pardo Lameda, Ivanesa L.; Brebbia, John S.; Koch, Timothy R. (BP International, 2024-11-27)
    Background: Temporal prevalence studies of worldwide obesity have confirmed that this epidemic continues to worsen and investigators have suggested that the scope of this problem may indeed be underestimated. The pathogenesis of the condition is multifactorial and complex, and it has been suggested that early life exposure to environmental chemicals (termed obesogens) may be a major cause of this epidemic. Aims: Vertical sleeve gastrectomy has become the most common surgical intervention for medically-complicated obesity. This study was designed to examine the distribution of clinical subtypes of obesity (e.g. psychosocial factors, genetic risk, or obesogens) and to identify the best candidates for vertical sleeve gastrectomy based on clinical subtype. Study Design: This is a retrospective cohort study in a large, urban teaching hospital. Place and Duration of Study: Center for Advanced Laparoscopic & Bariatric Surgery, MedStar Washington Hospital Center Washington, DC between October 2018 and June 2019. Methodology: Consecutive new individuals (n=225) with medically-complicated obesity were evaluated preoperatively in an outpatient bariatric gastroenterology clinic. Subjects (n=17) were excluded. Eighty-four individuals underwent sleeve gastrectomy with a minimum of 6 months of postoperative follow up.
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    Obesity Subtypes and Short Term Weight Loss After Vertical Sleeve Gastrectomy: A Retrospective Cohort Study
    Shah, Raj A.; Nath, Anand; Shope, Timothy R.; Pardo Lameda, Ivanesa L.; Brebbia, John S.; Koch, Timothy R. (2022-12)
    AIM: Vertical sleeve gastrectomy has become the most common surgical intervention for medically-complicated obesity. This study examines the hypothesis that a clinical subtype of obesity (psychosocial factors, genetic risk, or early life endocrine disruptors termed obesogens) can identify the best candidates for vertical sleeve gastrectomy. MATERIALS AND METHODS: This is a retrospective cohort study of 225 consecutive new individuals with medically-complicated obesity seen preoperatively in outpatient bariatric clinic in an urban community teaching hospital. Eighty-four individuals underwent sleeve gastrectomy with a minimum of 6 months of follow up. RESULTS: Among 3 subtypes, early life obesogen exposure has been identified in 14.5% of individuals, genetic risk in 24.5% of individuals, and psychosocial factors in 61% of individuals. Percent excess weight loss (mean+/-SD) at 6 months is different among the three groups (pANOVA = 0.024). Individuals with genetic risk (38%+/-14) have significantly less weight loss (p = 0.029) than individuals with psychosocial factors (47%+/-15), while there is no difference compared to the obesogen subtype (41%+/-8.9). CONCLUSION: The most common clinical subtype of obesity is psychosocial factors, and there is significantly higher short term weight loss after sleeve gastrectomy in individuals with psychosocial factors. Weight loss may be limited by an individual’s genetic risk and early life obesogen exposure. A prospective study is required to confirm these findings.
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    Vanishing Bile Duct Syndrome Associated With Estrogen
    Benfield, John; Shah, Raj A.; Grider, Douglas J.; Sahebjam, Farhad (Lippincott Williams & Wilkins, 2022-05)
    Vanishing bile duct syndrome (VBDS) refers to a form of cholestatic liver disease with many etiologies. Vanishing bile duct syndrome is characterized by biliary ductopenia and chronic cholestasis. This is a challenging condition for clinicians because of its rarity and unclear pathophysiology. Presented is an 18-year-old woman who developed cholestatic liver injury and intrahepatic biliary ductopenia after a course of oral contraceptives and intravenous estrogen for uterine bleeding. A year later, this patient did not have significant improvement in liver biomarkers and was referred for transplantation.