Blood alcohol concentrations rise rapidly and dramatically after Roux-en-Y gastric bypass

BACKGROUND

This study provides new information on how rapidly and extensively alcohol is absorbed after Roux-en-Y gastric bypass (RYGB). Previous alcohol pharmacokinetic research in RYGB patients has not reported blood alcohol concentrations in this early time period after ingestion. The objective of this study was to examine the rate and extent of alcohol absorption, particularly in the first 10 minutes after a dose of alcohol.

METHODS

Five female participants who had undergone RYGB 3 to 4 years previously completed the study. Participants were given .3 g/kg of actual weight of ethanol. After the dose of alcohol, blood samples were collected through an indwelling intravenous catheter every minute for the first 5 minutes and at 7.5, 10, 20, and 60 minutes.

RESULTS

The observed mean Cmax was 138.4±28.6 mg/dL (range 98.0-170.0 mg/dL), and the observed mean Tmax was 5.4±3.1 minutes (range 2-10 minutes) after alcohol consumption.

CONCLUSIONS

Within minutes after consumption of a beverage containing a modest amount of alcohol, post-RYGB patients achieve disproportionately high blood alcohol concentrations. All 5 participants in this study reached blood alcohol concentrations>.08%, the legal driving limit in the United States, within 10 minutes after a dose of alcohol. Clinicians are encouraged to educate patients about the marked changes in alcohol pharmacokinetics that are they are likely to experience after RYGB and to guide patients in making modifications to alcohol intake after surgery accordingly.

A model case of a positive outcome in super-super obesity

For an increasing number of obese patients, bariatric surgery is considered as the treatment of choice after the failure of conventional strategies. While numerous studies on bariatric surgery have shown substantial health benefits, there is a broad inter-individual variation in the long-term outcome, which is insufficiently understood. Here we show a favourable long-term outcome following multidisciplinary care in a super-super-obese patient. The patient suffered from numerous typically obesity-associated comorbidities and limitations. He underwent multidisciplinary care including two-step bariatric intervention. Endoscopic intragastric balloon positioning was followed by gastric sleeve surgery without Roux-en-Y gastric bypass. His body weight dropped from 260 kg (body mass index [BMI] 79.4 kg m(-2) ) to 85 kg (BMI 25.9 kg m(-2) ) within 16 months and continued to be stable at 90 kg (BMI 27.8 kg m(-2) ) at the end of the follow-up period of 48 months. The loss of excess body weight was associated with the remission of numerous obesity-related comorbidities and with a concomitant pronounced increase in the quality of life and in the socioeconomic status. Eventually, the patient was able to lead a normal life with a decreased risk of long-term complications. We attribute the positive long-term outcome to the following potential determinants: individualized bariatric surgery, multidisciplinary care, the patient's long-term compliance, adequate adherence to the aftercare, physical exercise after surgery, family support, the cooperation of the primary care physician and the financial coverage by the health insurance. Some of these factors remain to be evaluated as predictors of a favourable long-term outcome in prospective trials.

Pharmacotherapies for Overeating and Obesity

Obesity has become pandemic, and the annual cost in related illnesses and loss of productivity is already over $100 billion and rising. Research has shown that obesity can and does cause changes in behavior and in the brain itself that are very similar to changes caused by drugs of abuse. While food addiction is not the causal agent of all obesity, it is clear that many people no longer eat to survive, but instead survive to eat. This review considers the importance of the brain's reward system in food intake. The review also examines research developments and current treatments for obesity, including diet and exercise, psychotherapy, surgical interventions, and pharmacotherapies. Finally we discuss alterations in American society that are necessary for change to occur, and the diffculties therein.

A prior history of substance abuse in veterans undergoing bariatric surgery

BACKGROUND

The rates of obesity and substance abuse are high among US veterans.

OBJECTIVE

To examine weight loss and substance abuse rates following bariatric surgery in veterans with a history of substance abuse (SA).

METHODS

A prospective database of consecutive bariatric operations was reviewed. Data for SA patients were compared to patients without a substance abuse history (NA). Behavioral medicine staff followed patients throughout the pre- and postoperative courses.

RESULTS

Of 205 bariatric surgery patients, there were 74 (36.1%) SA patients. The mean preoperative body mass index (BMI) was 46.2 ± 8.1 kg/m², and percent excess weight loss at 12 months was 71.8%, 58.0%, and 33.5% for Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic gastric banding, respectively, not significantly different than the NA group (P = 0.15, 0.75, 0.96). Postoperative substance abuse in SA and NA patients was 8.1% and 1.5%, respectively (P = 0.234).

CONCLUSION

A prior history of substance abuse is common in veterans undergoing bariatric surgery; weight loss results are comparable to the general veteran bariatric cohort. Rates of substance abuse are low postoperatively, but higher in patients without a prior history of substance abuse. Close multidisciplinary followup throughout the postoperative course is likely to be integral to the patient's success.