In the current review we summarize the available data concerning the gastric hormone ghrelin and its receptor. Ghrelin stimulates short-term food intake and long-term body weight regulation via its adipogenic and diabetogenic effects. Ghrelin stimulates gastric emptying, and these effects could be explored from a therapeutic point of view. Ghrelin levels change profoundly in anorexia, in states of insulin resistance, in obesity, and after bariatric surgery, suggesting that this is an important hormone in body weight regulation.

Rheumatoid arthritis (RA) is a systemic inflammatory disease with a particular predilection for causing pain, deformity and functional limitation affecting the hands. Measures of the severity of RA, such as the disease activity score with 28 joint count may not fully reflect the regional impact of RA on the hands. Hand grip strength measurements are a form of objective assessment that focuses specifically on the hands in RA. This review explores what is currently known about the assessment of hand grip strength; what it may indicate, how it is measured, some of the practical aspects and challenges associated with performing these tests, and how this information can be applied in a clinical setting. It summarises the role that grip strength has in assessing patients with RA and finishes with some recommendations for how to use grip strength measurements in clinical practice, and what direction future research might take.

It has been previously demonstrated that RYGB surgery is associated with an increased incidence of fractures, and with reduction in bone mineral density. Patients undergoing bariatric surgery are frequently vitamin D deficient pre-operatively and show variable responses to vitamin D supplementation in the post-operative period. With particular reference to the RYGB procedure, there is evidence from several studies that bone mineral density is reduced at 12 and 24 post-operative months. To the best of our knowledge, this case may be the first time that multiple vertebral fractures have been documented so soon after weight loss surgery. It therefore highlights the growing conclusion that early consideration must be given to the maintenance of bone health in patients undergoing weight loss surgery.

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