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Pharmacotherapy Boosts Weight Loss Effects of Intragastric Balloons

This transcript has been edited for readability.

Alok S. Patel, MD: This is Dr Alok Patel with Medscape, right here at Digestive Disease Week 2019 overlaying all types of fascinating gastrointestinal (GI) subjects. I am honored to be speaking to Dr Reem Sharaiha, director of interventional gastroenterology at NewYork-Presbyterian/Weill Cornell Medical Center.

Dr Sharaiha, we will speak about your superb research[1] taking a look at pharmacotherapy and intragastric balloons. We know that intragastric balloons can result in a few 10%-15% complete physique weight loss, however some sufferers regain weight after they’ve them eliminated. Can you inform us slightly bit about the way you and your co-investigators designed this research and why you checked out what you probably did?

Reem Z. Sharaiha, MD, MSc: We know from the obesity knowledge that many sufferers need minimally invasive procedures with very low side-effect profiles that offer you somewhat bit extra profit than food plan and exercise and drugs. Balloons match that class as a result of they’re protected and reversible; sufferers like them rather a lot. We know from US Food and Drug Administration knowledge that sufferers lose weight when these balloons are current, as a result of they lower gastric quantity and delay emptying, food stays within the abdomen longer, and sufferers really feel full. However, all balloons should be eliminated sooner or later, often on the 6-month mark. When that occurs, sufferers lose these advantages and begin regaining weight . We questioned what the impact can be of including drugs. There has been just one very small research[2] in Europe taking a look at that, however it was underpowered to point out any distinction. So we thought we might take a look at our cohort of sufferers and examine outcomes between those that needed to have drugs added and people who did not.

Patel: How did you and your co-investigators determine which drugs to make use of within the research?

Sharaiha: It was on the discretion of the gastroenterologist and endocrinologist, and in addition the sufferers. There are 5 accredited drugs for weight loss. There can also be metformin, which is a medicine used primarily for diabetes however we use it off-label for weight loss; that is often the primary treatment that we begin with as a result of it has the most secure profile. Then we make different treatment selections based mostly on the affected person’s profile, by asking what causes them to have weight regain. Some individuals have cravings, some have nighttime consuming, and a few simply really feel hungry on a regular basis. We use differing types of drugs to cease that time limit that causes them to regain weight.

What we discovered is that sufferers who’ve pharmacotherapy proceed to lose weight even after the balloon is eliminated in contrast with those who did not have any pharmacotherapy. Now, it is essential to say that each teams have weight loss plan and exercise and in addition contacts with a dietitian or nutritionist each month. But the addition of pharmacotherapy simply gave that additional bang on your buck, they usually had a statistically vital weight loss on the 1-year mark.

Patel: Do you assume that the actual drawback you are fixing is curbing urge for food with pharmacotherapy?

Sharaiha: It’s not simply curbing urge for food however displaying that to be able to get sustained weight loss, you actually should see weight problems as a continual illness. You’re going to wish a number of factors within the affected person’s life to provide them some type of remedy. Whether it is balloons now, balloons plus drugs, and perhaps one thing else down the road, that is what we’ve got to assume of. In order to get weight loss that is just like with surgical procedure, it might be that the mixture strategy of an endoscopic bariatric remedy plus drugs will give them that choice.

Patel: I am glad you talked about that balloons are rising in popularity. We know that they are protected. How do you assume your research goes to have an effect on the longer term? Are we getting into an period of new requirements with balloons and pharmacotherapy? Would you wish to see gastroenterologists wanting into it extra?

Sharaiha: We consider that weight problems is a GI illness. It impacts so many issues inside the GI tract. It’s one of the most typical causes for sufferers to wish care. Therefore, each gastroenterologist ought to see that if sufferers have a physique mass index above 30, they need to be provided some type of remedy. They can begin with balloons, however additionally they have the choice of perhaps including drugs to assist them increase their weight loss. And in the event that they really feel they can not do it or do not feel snug doing it, then they will associate with an endocrinologist or an inner drugs physician who may give drugs.

Patel: Because drugs is teamwork.

Sharaiha: Exactly.

Patel: Your research checked out sufferers on the 12-month mark. Are you occupied with wanting additional than that?

Sharaiha: Yes, for positive. The 12-month mark is often the simplest knowledge to get after which often after that, sufferers peter off. I might clearly wish to maintain following this cohort longitudinally and see what occurs to them. But the research I might ideally love to do subsequent is a potential trial giving drugs versus not, in a extra rigorous trend. The present research is clearly retrospective, so that you need to see this prospectively so you’ve got arduous endpoints the place you possibly can argue that this must be the usual of care.

Patel: Dr Sharaiha, thanks a lot for speaking to us. We’re wanting ahead to seeing the outcomes sooner or later.

Sharaiha: Thank you for having me.

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