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| Name | Class |
|---|---|
| Kansas City Heart Rhythm Institute | OTHER |
| Bariatric and Metabolic Specialists, Overland Park, KS | UNKNOWN |
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Observational two phase, retrospective and prospective registry study to assess the prevalence of and characterize outcomes of autonomic dysfunction (AD) in patients who undergo bariatric surgery (BS) and to better define the underlying pathophysiology of AD following BS.
Previous studies have investigated the incidence of OI (orthostatic intolerance) with BS. One recent meta-analysis only found a 5-year cumulative incidence of 4.2%, challenging reports of increased incidence. However, this same study recognized the limited and low-quality evidence investigating this phenomenon. Other meta-analyses found only four studies each that matched their search criteria, highlighting the lack of evidence. Thus, this study is designed to investigate the prevalence and better understand AD/OI after BS.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Development of AD/OI after BS. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Development of AD/OI after BS | Other | OI is a type of AD that results in chronic supine-to-standing hypotension and disabling dizziness, lightheadedness, and even syncope. Whether arising from malabsorption, vagus nerve damage, or splanchnic vasodilation, the pathophysiology of OI in bariatric surgery is not clear and requires more investigation. Treatment of OI usually consists of dietary and lifestyle changes, which may include compression stockings and abdominal binders. Medical options include peripheral vasoconstrictors and mineralocorticoids; some patients may be referred to Cardiology for further testing. Management is difficult and endurance and tilt training, inflatable abdominal bands, and beta-blockers have been proposed. One recent study demonstrated the treatment of refractory OI with Droxidopa. Yet, the success of treatment is individualized and necessitates more novel approaches. |
| Measure | Description | Time Frame |
|---|---|---|
| To assess the prevalence of and characterize outcome of autonomic dysfunction (AD) in patients who undergo bariatric surgery (BS) | 3 Months |
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Inclusion Criteria:
Exclusion Criteria:
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Phase I: who have undergone bariatric surgery in the last 3 years. Phase II: who will undergo bariatric surgery within the next 3 months.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Donita Atkins | Contact | 816-651-1969 | datkins@kchrf.com |
| Name | Affiliation | Role |
|---|---|---|
| Dhanunjaya Lakkireddy | Kansas City Heart Rhythm Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Menorah Medical Center | Recruiting | Overland Park | Kansas | 66209 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36725453 | Background | Lazzati A. Epidemiology of the surgical management of obesity. J Visc Surg. 2023 Apr;160(2S):S3-S6. doi: 10.1016/j.jviscsurg.2022.12.004. Epub 2023 Jan 30. | |
| 32870301 | Background | Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020 Sep 1;324(9):879-887. doi: 10.1001/jama.2020.12567. |
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| Bariatric and Metabolic Specialists | Recruiting | Overland Park | Kansas | 66211 | United States |
|
| Kansas City Heart Rhythm Institute - Roe Clinic | Recruiting | Overland Park | Kansas | 66211 | United States |
|
| Overland Park Regional Medical Center | Recruiting | Overland Park | Kansas | 66215 | United States |
|
| Centerpoint Medical Center Clinic | Recruiting | Independence | Missouri | 64057 | United States |
|
| Centerpoint Medical Center | Recruiting | Independence | Missouri | 64057 | United States |
|
| Research Medical Center Clinic | Recruiting | Kansas City | Missouri | 64032 | United States |
|
| Research Medical Center | Recruiting | Kansas City | Missouri | 64032 | United States |
|
| 32128245 | Background | Zhang JB, Tamboli RA, Albaugh VL, Williams DB, Kilkelly DM, Grijalva CG, Shibao CA. The incidence of orthostatic intolerance after bariatric surgery. Obes Sci Pract. 2019 Dec 6;6(1):76-83. doi: 10.1002/osp4.383. eCollection 2020 Feb. |
| Background | Rodriguez Ruben, J., et al., AUTONOMIC DYSFUNCTION FOLLOWING BARIATRIC SURGERY. Journal of the American College of Cardiology, 2021. 77(18_Supplement_1): p. 327-327 |
| 9111544 | Background | Tanaka H, Yamaguchi H, Tamai H. Treatment of orthostatic intolerance with inflatable abdominal band. Lancet. 1997 Jan 18;349(9046):175. doi: 10.1016/S0140-6736(97)24003-1. No abstract available. |
| 9474671 | Background | Ector H, Reybrouck T, Heidbuchel H, Gewillig M, Van de Werf F. Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol. 1998 Jan;21(1 Pt 2):193-6. doi: 10.1111/j.1540-8159.1998.tb01087.x. |
| 11198485 | Background | Freitas J, Santos R, Azevedo E, Costa O, Carvalho M, de Freitas AF. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone. Clin Auton Res. 2000 Oct;10(5):293-9. doi: 10.1007/BF02281112. |
| 15699447 | Background | Winker R, Barth A, Bidmon D, Ponocny I, Weber M, Mayr O, Robertson D, Diedrich A, Maier R, Pilger A, Haber P, Rudiger HW. Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension. 2005 Mar;45(3):391-8. doi: 10.1161/01.HYP.0000156540.25707.af. Epub 2005 Feb 7. |
| 35678018 | Background | Kokorelis C, Bodurtha J, Guthrie K, Rowe PC. Successful Treatment of Refractory Orthostatic Intolerance (OI) With Droxidopa. Clin Pediatr (Phila). 2022 Oct;61(9):593-595. doi: 10.1177/00099228221092645. Epub 2022 Jun 8. No abstract available. |
| 34409762 | Background | Al Nou'mani J, Al Alawi AM, Falhammar H, Al Qassabi A. Orthostatic intolerance after bariatric surgery: A systematic review and meta-analysis. Clin Obes. 2021 Dec;11(6):e12483. doi: 10.1111/cob.12483. Epub 2021 Aug 19. |
| 33655427 | Background | Kermansaravi M, Chiappetta S, Lainas P, Kassir R. Orthostatic Intolerance after Bariatric Surgery: a Systematic Review. Obes Surg. 2021 May;31(5):2250-2254. doi: 10.1007/s11695-021-05266-4. Epub 2021 Mar 2. |
| 35133603 | Background | Addison P, Carsky K, Patti ME, Roslin M. Hypoglycemia and Dysautonomia After Bariatric Surgery: a Systematic Review and Perspective. Obes Surg. 2022 May;32(5):1681-1688. doi: 10.1007/s11695-022-05960-x. Epub 2022 Feb 8. |
| 28096259 | Background | Honka H, Koffert J, Kauhanen S, Teuho J, Hurme S, Mari A, Lindqvist A, Wierup N, Groop L, Nuutila P. Bariatric Surgery Enhances Splanchnic Vascular Responses in Patients With Type 2 Diabetes. Diabetes. 2017 Apr;66(4):880-885. doi: 10.2337/db16-0762. Epub 2017 Jan 17. |
| 25561784 | Background | Hatipoglu S, Akbulut S, Hatipoglu F, Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments. World J Gastroenterol. 2014 Dec 28;20(48):18165-76. doi: 10.3748/wjg.v20.i48.18165. |
| 30800305 | Background | Williams WH 3rd, Browne RC, Bui TP, Holmes AA, Thakar D. Case report on intravenous octreotide for the treatment of intraoperative vasoplegia following thymoma resection. SAGE Open Med Case Rep. 2019 Feb 8;7:2050313X19827744. doi: 10.1177/2050313X19827744. eCollection 2019. |
| 24297127 | Background | Chan MM, Chan MM, Mengshol JA, Fish DN, Chan ED. Octreotide: a drug often used in the critical care setting but not well understood. Chest. 2013 Dec;144(6):1937-1945. doi: 10.1378/chest.13-0382. |
| 10706544 | Background | Chatila R, Ferayorni L, Gupta T, Groszmann RJ. Local arterial vasoconstriction induced by octreotide in patients with cirrhosis. Hepatology. 2000 Mar;31(3):572-6. doi: 10.1002/hep.510310304. |
| 19299324 | Background | Karwa R, Woodis CB. Midodrine and octreotide in treatment of cirrhosis-related hemodynamic complications. Ann Pharmacother. 2009 Apr;43(4):692-9. doi: 10.1345/aph.1L373. Epub 2009 Mar 18. |
| ID | Term |
|---|---|
| D054969 | Primary Dysautonomias |
| D054971 | Orthostatic Intolerance |
| ID | Term |
|---|---|
| D001342 | Autonomic Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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