Article

Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery: Ethanol kinetics after gastric bypass

Department of Surgery, University Hospital, Orebro, Sweden.
British Journal of Clinical Pharmacology (Impact Factor: 3.69). 01/2003; 54(6):587-91. DOI: 10.1046/j.1365-2125.2002.01698.x
Source: PubMed

ABSTRACT To investigate the absorption, distribution and elimination of ethanol in women with abnormal gut as a result of gastric bypass surgery. Patients who undergo gastric bypass for morbid obesity complain of increased sensitivity to the effects of alcohol after the operation.
Twelve healthy women operated for morbid obesity at least 3 years earlier were recruited. Twelve other women closely matched in terms of age and body mass index (BMI) served as the control group. After an overnight fast each subject drank 95% v/v ethanol (0.30 g kg-1 body weight) as a bolus dose. The ethanol was diluted with orange juice to 20% v/v and finished in 5 min. Specimens of venous blood were taken from an indwelling catheter before drinking started and every 10 min for up to 3.5 h post-dosing. The blood alcohol concentration (BAC) was determined by headspace gas chromatography.
The maximum blood-ethanol concentration (Cmax) was 0.741 +/- 0.211 g l-1 (+/- s.d.) in the operated group compared with 0.577 +/- 0.112 g l-1 in the controls (mean difference 0.164 g l-1, 95% confidence interval (CI) 0.021, 0.307). The median time to peak (tmax) was 10 min in the bypass patients compared with 30 min in controls (median difference -15 min (95% CI -10, -20 min). At 10 and 20 min post-dosing the BAC was higher in the bypass patients (P < 0.05) but not at 30 min and all later times (P > 0.05). Other pharmacokinetic parameters of ethanol were not significantly different between the two groups of women (P > 0.05).
The higher sensitivity to ethanol after gastric bypass surgery probably reflects the more rapid absorption of ethanol leading to higher Cmax and earlier tmax. The marked reduction in body weight after the operation might also be a factor to consider if the same absolute quantity of ethanol is consumed.

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    • "The education and guided discussion about alcohol and bariatric surgery covers specific information designed to inform patients about the possible risks. Patients are informed that alcohol might be much more intoxicating after surgery [4] [10], with a single glass of wine potentially putting some gastric bypass patients' alcohol levels over the legal driving limit of .08 [12]. We also note that bariatric patients can show different symptoms of intoxication (e.g., dizziness), and some might take almost twice as long to return to sobriety [12]. "
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    ABSTRACT: Established clinical guidelines identify current alcohol abuse and dependence as contraindications for weight loss surgery. However, guidance on how to best assess alcohol use in bariatric patients has not been elucidated. Furthermore, concerns with postoperative alcohol use/abuse and increased sensitivity warrant the development of recommendations on appropriate interventions for patients pursuing weight loss surgery. Our objective was to review the current data on bariatric surgery and substance abuse/addiction, with an emphasis on alcohol use, offer guidance on how to assess the risk of such problems, and provide preliminary recommendations on treating high-risk patients. The relevant published data on alcohol use, abuse, and dependence in pre- and postoperative bariatric patients was reviewed. Also, the putative mechanisms of increased alcohol sensitivity after weight loss surgery were examined. Although current alcohol abuse/dependence is less than that in population-base rates, bariatric surgery candidates have a greater history of alcohol use disorders. Physiologic changes after surgery can also change vulnerability to problematic alcohol use, and many patients continue to consume alcohol after surgery. Assessment techniques and strategies to provide informed consent and education on alcohol were included from the Bariatric and Metabolic Institute at the Cleveland Clinic. Weight loss surgery candidates might have a greater lifetime risk of alcohol use disorders and greater sensitivity to the intoxicating effects of alcohol after surgery. Adequate screening, assessment, and preoperative preparation could help mitigate this risk. Future research should examine the efficacy of such risk management strategies.
    Surgery for Obesity and Related Diseases 02/2012; 8(3):357-63. DOI:10.1016/j.soard.2012.01.016 · 4.94 Impact Factor
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    • "The portal venous blood first passes to the liver, then on to heart and via the lungs throughout the entire systemic circulation. The absorption rate of alcohol is faster when gastric emptying is rapid because alcohol passes more quickly through the pyloric sphincter (Klockhoff et al., 2002). Factors that influence gastric emptying, such as food in the stomach, are important determinants of the rate of absorption of alcohol and the maximum concentration in the blood (C max ), as well as the intensity of the effects of alcohol on the individual (Jones and Jonsson, 1994). "
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    ABSTRACT: Background: Obesity can be associated with psychiatric disorders such as depression. Aim: To determine the prevalence and association of psychiatric disorders in patients with excess body weight. Methods: Patients scheduled for weight reduction surgery were included. For each patient, pre-surgical clinical and psychiatric data were collected. Follow-up data were available 1-year after surgery. Patients with psychiatric disorders were compared to those without psychiatric disorders. Mann-Whitney non-parametric test was used for comparison of numerical parameters, while prevalence of certain clinical and demographic events were validated using chi-square homogeneity test. Results: 499 patients were included: age: 42.8 ±11.0 years, 20% male, 76% Caucasians, BMI 46.8 ± 10.8, ALT 32.5 ± 21.7 and AST 25.0 ± 14.3. At baseline, a history of psychiatric disorder was documented in 214 (43%) patients (depression in 35% of patients, anxiety in 6% and other psychiatric diagnosis in 2.2%). Patients with a history of depression were older (p=0.0021), more likely to report a history of drinking alcohol either at baseline (p=0.0434) or 1-year after surgery (p= 0.0302), and more likely to be female (p=0.0079) and Caucasian (p=0.0096) than patients without psychiatric history. The depression cohort of this study also had significantly higher triglyceride levels (p= 0.0492) than any other psychiatric diagnosis cohort, and the highest rates of hyperlipidemia (p = 0.012) and hypertension diagnoses (p = 0.0074) out of all cohorts, including the cohort of subjects never diagnosed with a psychiatric disorder. Conclusions: Patients undergoing weight reduction surgery seem to have high prevalence of depression and anxiety. Patients previously diagnosed with depression also appear to have a significantly higher rate of hypertension and hyperlipidemia than patients who were never diagnosed with a psychiatric disorder.
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