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Review
. 2022 Sep;10(7):663-720.
doi: 10.1002/ueg2.12280. Epub 2022 Aug 12.

European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

Stephan C Bischoff  1 , Rocco Barazzoni  2 , Luca Busetto  3 , Marjo Campmans-Kuijpers  4 , Vincenzo Cardinale  5 , Irit Chermesh  6 , Ahad Eshraghian  7 , Haluk Tarik Kani  8 , Wafaa Khannoussi  9   10 , Laurence Lacaze  11   12   13 , Miguel Léon-Sanz  14 , Juan M Mendive  15 , Michael W Müller  16 , Johann Ockenga  17 , Frank Tacke  18 , Anders Thorell  19   20 , Darija Vranesic Bender  21 , Arved Weimann  22 , Cristina Cuerda  23
Affiliations
Review

European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline

Stephan C Bischoff et al. United European Gastroenterol J. 2022 Sep.

Abstract

Background: Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence.

Objective: The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity.

Methods: The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference.

Results: In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician.

Conclusion: The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.

Keywords: bariatric surgery; celiac disease; cirrhosis; gastroesophageal reflux disease; inflammatory bowel disease; irritable bowel syndrome; non-alcoholic fatty liver disease; obesity; pancreatitis; sarcopenic obesity.

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Conflict of interest statement

The expert members of the working group were accredited by the ESPEN Guidelines Group, the ESPEN Education and Clinical Practice Committee, the ESPEN executive, and the UEG Quality of Care Task Force. All expert members have declared their individual conflicts of interest according to the rules of the International Committee of Medical Journal Editors. If potential conflicts were indicated, they were reviewed by the ESPEN guideline officers and, in cases of doubts, by the ESPEN executive. None of the expert panel had to be excluded from the working group or from co‐authorship because of serious conflicts.

Stephan C. Bischoff reports personal fees from Nestlé, personal fees from Hexal AG, personal fees from Dr. Wild & Co. AG, personal fees from SymbioPharm GmbH, other from Yakult Deutschland GmbH, other from Ardeypharm GmbH, and other from Thieme, outside the submitted work. Luca Busetto reports personal fees from Novo Nordisk, personal fees from Bruno Farmaceutici, personal fees from Rythm, personal fees from Therascience, personal fees from Pronokal, grants from Enzymmanagement, outside the submitted work. Marjo Campmans‐Kuijpers reports personal fees from Janssen, and personal fees from Takeda, outside the submitted work. Laurence Lacaze reports non‐financial support from Nutricia, non‐financial support from Air de Bretagne, and non‐financial support from Fresenius Kabi, outside the submitted work. Miguel Leon‐Sanz reports personal fees from Abbott, grants from Abbott, personal fees from Fresenius Kabi, personal fees from Danone, personal fees from Nestle, personal fees from Persan, personal fees from Takeda, personal fees from Vegenat, outside the submitted work. Johann Ockenga reports personal fees from Dr. Willmar Schwabe GmbH & Co. KG, personal fees from Hexal AG, personal fees from Falk Foundation e.V., outside the submitted work. Frank Tacke reports grants from Allergan, Gilead, BMS, Inventiva, and personal fees from Allergan, Gilead, Galmed, AbbVie, BMS, Boehringer, Galapagos, Intercept, Falk, Inventiva, NovoNordisk outside the submitted work. Darija Vranesic Bender reports personal fees from Abbott, personal fees from Fresenius Kabi, personal fees from Nutricia, personal fees from Nestle, personal fees from Novo Nordisk, outside the submitted work. Arved Weimann reports personal fees from Baxter, grants and personal fees from B. Braun, personal fees from Fresenius Kabi, personal fees from Falk Foundation, grants from Mucos, grants from Seca, outside the submitted work. Cristina Cuerda reports personal fees from FRESENIUS KABI, non‐financial support from PERSAN FARMA, personal fees from NUTRICIA, personal fees from SHIRE, and personal fees from ABBOTT, outside the submitted work. Rocco Barazzoni, Vincenzo Cardinale, Irit Chermesh, Ahad Eshraghian, Haluk Tarik Kani, Wafaa Khannoussi, Juan M. Mendive, Michael W. Müller, and Anders Thorell declare that there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
European association for the study of the liver Clinical Practice Guidelines on nutrition in chronic liver disease (CLD)
See this image and copyright information in PMC

Comment in

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