A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults

Mounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern. Additionally, young adults and racial/ethnic minorities are both increasingly undergoing WLS and are at heightened risk for problems related to alcohol use. To date, these groups have been under-represented in study samples. To address these important gaps in the literature, racially/ethnically diverse, young adult WLS patients who indicated a post-WLS increase in alcohol use (n = 12) participated in an individual, semi-structured qualitative interview. Data were analyzed through two coding cycles; an external audit of the emerging themes was also conducted to further ensure the trustworthiness of the data. Interviews revealed four major themes prompting an increase in alcohol use after WLS: (1) increased sensitivity to alcohol intoxication, (2) utilizing alcohol as a replacement self-soothing mechanism for food, (3) increase in socialization, and (4) utilizing alcohol as a coping mechanism. By understanding the drivers of increases in alcohol use after WLS, precision-targeted pre- and post-surgical counseling interventions can be developed to address this emerging concern

Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients

Background: Research suggests that young adults and racial/ethnic minorities are at an increased risk for problematic alcohol use. Recent studies have also documented patterns of problematic alcohol use among a subset of weight loss surgery (WLS) patients. However, to date, there are no published studies investigating the intersection of these demographic and clinical characteristics. Methods: This study used descriptive and inferential analyses to examine alcohol use patterns, prevalence of pre- and post-WLS alcohol use disorders (AUDs), and predictors of increased alcohol use and problematic alcohol use post-WLS among young adult (mean age 26.5 years, SD = 5.5 years) ethnically diverse (57% Hispanic, 28% non-Hispanic black) WLS patients (N = 69). Results: Over 21% of the sample had a history of a lifetime AUD, and 4.2% of the sample developed an AUD post-WLS. In the past 30 days, 14.5% of respondents reported binge drinking, and 42% reported drinking until intoxication. History of a pre-WLS AUD was associated with an increased frequency of alcohol use post-WLS (P = .012). Age, time since WLS, the gastric bypass procedure, and pre-WLS history of an AUD were not significant predictors of binge drinking or drinking to intoxication post-WLS. Conclusions: Ethnically diverse, young adults may have an elevated prevalence of AUD diagnoses pre-WLS. Having a pre-WLS AUD appears to be a risk factor for increased alcohol use post-WLS. Young adult WLS patients might also demonstrate high rates of binge drinking and drinking to intoxication. Binge drinking could be especially problematic considering that WLS could increase sensitivity to alcohol. Further investigation is warranted with this important subpopulation to explore risk factors for problematic alcohol use post-WLS; future assessments of alcohol use should consider potential heightened alcohol sensitivity resulting from WLS

Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: a multicenter case-control study

Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Academic Hospitals and Private Practices, United States. A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4–99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2–137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8–62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation. Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort

Predictors of Short-Term Diabetes Remission After Laparoscopic Roux-en-Y Gastric Bypass

A remission of type 2 diabetes mellitus (T2DM) is one of the major goals of the contemporary bariatric surgery. The goal of our study is to identify predictors of short-term postoperative diabetes remission in order to facilitate preoperative patient selection. Two hundred forty-five obese (body mass index (BMI) ≥35 kg/m2) T2DM subjects who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) were followed up to 1 year after bariatric surgery. Diabetes remission was defined as hemoglobin A1c (HbA1c) ≤6 % and fasting blood glucose (FBG) <100 mg/dl in absence of all diabetic medications. Twenty-six percent of the patients seen in f/u achieved complete remission at 1 year. Average Hba1c decreased from 8 to 6.7% and 6.4% after 6 and 12 months, respectively. Regression analysis showed that age (p = 0.01), number of diabetes complications (p = 0.03), family history of diabetes (p = 0.04), preoperative use of insulin (p = 0.04), and peri- and postoperative weight loss (p = 0.05, for both) were the best preoperative predictors of diabetes remission at 6 and 12 months (R(2) = 0.3). Younger patients, with fewer diabetic complications, no family history of diabetes, not using insulin, and with greater peri- and postoperative weight loss were the best candidates to achieve a rapid diabetes remission after RYGB

Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| &lt; 0.8) in the transverse momentum range 1 &lt; pt &lt; 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs

Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review

The selection criteria, safety, and efficacy of bariatric surgery are well established in adults but are less well defined for severely obese adolescents. The number of severely obese adolescents who could benefit from weight loss surgery is increasing, although referral rates have plateaued. Surgical options for these adolescents are controversial and raise several questions. Recent studies, including the prospective Teen-Longitudinal Assessment of Bariatric Surgery Study and the Adolescent Morbid Obesity Surgery Study, help answer these questions. Early bariatric surgical intervention improves body mass index but, more importantly, improves cardiovascular and metabolic co-morbidities of severe obesity. A review of the medical, psychosocial, and economic risks and benefits of bariatric surgery in severely obese adolescents is a step toward improving the management of a challenging and increasing population. We describe the current knowledge of eligibility criteria, preoperative evaluation, surgical options, outcomes, and referral barriers of adolescents for bariatric surgery