Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations

Inocian, Ergie Pepito; Nolfi, David; Felicilda-Reynaldo, Rhea Faye D; Bodrick, Mustafa M.; Aldohayan, Abdullah; Kalarchian, Melissa A.

doi:10.1016/j.soard.2021.06.015

Cited by 20 publications

(13 citation statements)

References 73 publications

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“…There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative EGD in bariatric surgery [35]. A total of 65% of 148 International Federation for the Surgery of Obesity and Metabolic Disorders-Middle East and North Africa Chapter (IFSO-MENAC) surgeon members who responded to a survey in 2019 reported that they did not request routine preoperative endoscopy for patients undergoing bariatric surgeries [36].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

Aljaroudi¹,

Makki²,

Almulaify³

et al. 2023

Cureus

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Background: There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation.Material and Methods: This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their prebariatric-surgery evaluation.Results: A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m 2 , respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have Helicobacter pylori infection. Conclusion:The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Rouxen-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of H. pylori infections in obese patients are important but it is not clear whether H. pylori eradication should be done before bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

Aljaroudi¹,

Makki²,

Almulaify³

et al. 2023

Cureus

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“…The adoption of a more modern lifestyle and alterations in the perceptions of the “ideal body” may also have played an important role in the estimated increase in the burden of BN in MENA (Gerisch et al, 2018; Malecki et al, 2018). Modernity has come with a new perspective on the ideal body shape, which has given rise to many body shape‐altering practices, such as bariatric or cosmetic surgery, as well as the psychological stress of wanting to have a more desirable body (Gerisch et al, 2018; Inocian et al, 2021). Furthermore, as BN is a mental condition, BN‐associated morbidity might not be as easily identified as more acute or fulminant diseases (such as infectious diseases and trauma), and thus BN‐related mortality might be missed in less developed healthcare systems, especially in countries at war.…”

Section: Discussionmentioning

confidence: 99%

The estimated burden of bulimia nervosa in the Middle East and North Africa region, 1990–2019

Safiri

Noori

Nejadghaderi

et al. 2022

Intl J Eating Disorders

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Objective We aimed to report the burden of bulimia nervosa (BN) in the Middle East and North Africa (MENA) region by age, sex, and sociodemographic index (SDI), for the period 1990–2019. Methods Estimates of the prevalence, incidence, and disability‐adjusted life‐years (DALYs) attributable to BN were retrieved from the Global Burden of Disease study 2019, between 1990 and 2019, for the 21 countries in the MENA region. The counts and age‐standardized rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals. Results In 2019, the estimated regional age‐standardized point prevalence and incidence rates of BN were 168.3 (115.0–229.6) and 178.6 (117.0–255.6) per 100,000, which represented 22.0% (17.5–27.2) and 10.4% (7.1–14.7) increases, respectively, since 1990. Moreover, in 2019 the regional age‐standardized DALY rate was 35.5 (20.6–55.5) per 100,000, which was 22.2% (16.7–28.2) higher than in 1990. In 2019, Qatar (58.6 [34.3–92.5]) and Afghanistan (18.4 [10.6–29.2]) had the highest and lowest age‐standardized DALY rates, respectively. Regionally, the age‐standardized point prevalence of BN peaked in the 30–34 age group and was more prevalent among women. In addition, there was a generally positive association between SDI and the burden of BN across the measurement period. Discussion In the MENA region, the burden of BN has increased over the last three decades. Cost‐effective preventive measures are needed in the region, especially in the high SDI countries. Public Significance This study reports the estimated burden of BN in the MENA region and shows that its burden has increased over the last three decades.

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“…Only limited guidance is presently available on use of bariatric surgery in ME populations. A recent review identified cultural-specific considerations that may affect bariatric care and outcomes in 6 domains: knowledge of bariatric surgery; mental health, body image, and quality of life; influence of family; religion and lifestyle; preoperative practices; and healthcare access ( 64 ). Because of the high burden of obesity in the ME, bariatric surgery is common; laparoscopic sleeve gastrectomy was reported to be the most frequently used procedure ( 65 ).…”

Section: Specific Recommendations and Discussionmentioning

confidence: 99%

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

et al. 2022

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Diabetes prevalence is on the rise in the Middle East. In countries of the Gulf region—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates—prevalence rates are among the highest in the world. Further, Egypt now ranks as one of the top 10 countries in the world for high number of people with diabetes. Medical nutrition therapy is key to optimal management of diabetes. Patient adherence to nutritional guidance depends on advice that is tailored to regional foods and cultural practices. In 2012, international experts created a transcultural Diabetes Nutrition Algorithm (tDNA) for broad applicability. The objective of this current project was to adapt the algorithm and supportive materials to the Middle East region. A Task Force of regional and global experts in the fields of diabetes, obesity, and metabolic disorders met to achieve consensus on Middle East-specific adaptations to the tDNA. Recommendations, position statements, figures, and tables are presented here, representing conclusions of the tDNA-Middle Eastern (tDNA-ME) Task Force. Educational materials can be used to help healthcare professionals optimize nutritional care for patients with type 2 diabetes. The tDNA-ME version provides evidence-based guidance on how to meet patients' nutritional needs while following customs of people living in the Middle Eastern region.

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Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations

Cited by 20 publications

References 73 publications

Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

The estimated burden of bulimia nervosa in the Middle East and North Africa region, 1990–2019

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

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