Prevalence of early dumping syndrome after primary Roux-en-Y gastric bypass

Background: Although early dumping syndrome is a well-known complication after Roux-en-Y Gastric Bypass (RYGB), data on the long-term prevalence are limited and inconclusive. This study aims to describe the prevalence of early dumping syndrome in patients 3 to 6 years after primary RYGB, using 3 different criteria. Methods: In this cross-sectional study a total of 140 patients after RYGB were randomly selected and approached. Of these, 51 patients agreed to participate in a Mixed-Meal Tolerance Test using a liquid nutrition supplement (Ensure Plus 200ml). The results of the first 28 are presented here. Heart Rate (HR) and Haematocrit (Ht) were measured at baseline and 10, 20, 30 and 60 minutes after the test meal. Symptoms scores were measured at baseline, 30 and 60 minutes. Early dumping was defined as a HR-increase of >10 beats per minute, a Ht-increase of >3%, and/or ≥2 gastrointestinal symptoms and ≥1 vegetative symptom on a symptom score. A confidence interval (CI) was calculated using the Clopper-Pearson method. Results: Prevalence of early dumping was 89% (n=25) according to HR (95% CI [0.72;0.98]); 32% (n=9) according to Ht (95% CI [0.16; 0.52]) and 7% (n=2) recorded symptom score (95% CI [0.01; 0.24]). In the vast majority the objective changes indicative of early dumping occurred within 10 minutes postprandially. Symptoms were reported within 30 minutes postprandially. Conclusions: The interim results show a large discrepancy of the prevalence of early dumping between the different criteria. Hemodynamic evidence of early dumping is only in a few cases accompanied by complaints

Long-term self-reported symptom prevalence of early and late dumping in a patient population after sleeve gastrectomy, primary, and revisional gastric bypass surgery

BACKGROUND: Early and late dumping are side effects of bariatric surgery. Almost no data are available on the prevalence of dumping after different surgical procedures. OBJECTIVES: Comparison of the relative risks of dumping in a large population of patients having undergone primary Roux-en-Y gastric bypass (pRYGB), sleeve gastrectomy (SG), or revisional RYGB (rRYGB; after removal of band). SETTING: Bariatric center of a teaching hospital. METHODS: In this descriptive cohort study, all patients who underwent a pRYGB (n = 615), SG (n = 157), or rRYGB (n = 274) between 2008 and 2011 were approached by mail and asked to complete and return a questionnaire of general and disease-specific questions related to dumping syndrome. Relative risks (RR) were calculated (mean with 95% confidence intervals) by comparing the prevalence of high suspicion for early and late dumping between different surgical procedure groups and primary gastric bypass surgery. RESULTS: The questionnaire was completed and returned by 593 (57%) of 1046 patients. Fewer patients with SG were at high suspicion of early dumping than after pRYGB (RR [95% confidence interval] .46 [.22-.99], P = .049). No differences for early dumping were seen between rRYGB and pRYGB (RR 1.21 [.77-1.91], P = .40). More patients were at high suspicion for late dumping after rRYGB compared with after pRYGB (RR 1.78 [1.09-2.90] P = .021). No differences for late dumping were seen between SG and pRYGB (RR .59 [.22-1.61], P =.30). CONCLUSION: Fewer complaints of early dumping are reported after SG, while patients report more complaints of late dumping after rRYGB compared with pRYGB

Influence of bariatric surgery on the use of some major drug classes

Introduction Patients undergoing bariatric surgery are severely obese and characterized by multidrug use for multiple comorbidities. Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. Aim To study the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type and number of medications and daily dosage. Methods A retrospective and prospective observational study was carried out in Medical Centre Leeuwarden. After having obtained written informed consent drug dispensing data from pharmacies were collected from patients undergoing their first bariatric surgery between January 2008 and September 2011. Dispensing data from 6 months before until 12 months after surgery were analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Results 450 patients were included (20.2% male). Mean age (SD) was 43.4 (10.1) yr; mean BMI (SD) was 44.9 (6.7) kg/m2. Roux-en-Y gastric bypass was performed in 74% of the patients. Mean BMI (SD) 12 months after surgery was 31.1 (5.6) kg/m2. The mean number of drugs per patient (95% CI) decreased from 3.66 (3.37-3.99) to 3.25 (3.04- 3.56). The mean number of drugs per patient decreased by 71%, 36%, 27%, 47%, 24% and 33% for antidiabetics, diuretics, beta blockers, agents acting on the reninangiotensin system, lipid modifying agents, and drugs for obstructed airway diseases respectively 12 months after surgery. From those drug classes patients used lower DDD 12 months after surgery. In contrast, a higher DDD was observed for thyroid hormone with no change in the mean number of drugs per patient. Conclusion Twelve months after bariatric surgery the use of drugs decreases in terms of mean number of drugs per patient and, for some major drug classes, in dose intensity. Dispensing data from pharmacies may provide detailed information on the use of medication by patients after bariatric surgery

Prevalence of hypoglycaemia in a random population after Roux-en-Y gastric bypass after a meal test

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) is an effective way to induce sustainable weight loss and can be complicated by postprandial hyperinsulinemic hypoglycaemia (PHH). To study the prevalence and the mechanisms behind the occurrence of hypoglycaemia after a mixed meal tolerance test (MMTT) in patients with primary RYGB. DESIGN: This is a cross-sectional study of patients four years after primary RYGB. METHODS: From a total population of 550 patients, a random sample of 44 patients completed the total test procedures. A standardized mixed meal was used as stimulus. Venous blood samples were collected at baseline, every 10 minutes during the first half hour and every 30 minutes until 210 minutes after the start. Symptoms were assessed by questionnaires. Hypoglycaemia defined as a blood glucose below 3.3 mmol/L. RESULTS: The prevalence of postprandial hypoglycaemia was 48% and was asymptomatic in all patients. Development of hypoglycaemia was more frequent in patients with lower weight at surgery (p = 0.045), with higher weight loss after surgery (p = 0.011), and with higher insulin sensitivity calculated by Homeostasis Model Assessment indexes (HOMA2-IR p = 0.014) and enhanced beta cell function (insulinogenic index at 20 minutes p = 0.001). CONCLUSION: In a randomly selected population four years after primary RYGB surgery 48% of patients developed a hypoglycemic event during a mixed meal tolerance test without symptoms, suggesting the presence of hypoglycaemia unawareness in these patients. The findings in this study suggest that the pathophysiology of PHH is multifactorial

Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: A single oral dose study before and after surgery

Objective: Roux-en-Y gastric bypass (RYGB) surgery induces major changes in the gastrointestinal tract that may alter the pharmacokinetics of orally administered drugs. Results from pharmacokinetic studies are sparse. This study aimed to investigate the effect of RYGB on the bioavailability of metoprolol from immediate release (IR) and controlled release (CR) tablets in female patient volunteers before and after surgery. Methods: An explorative, two-phase, single oral dose pharmacokinetic study of metoprolol in female patients undergoing RYGB was carried out. The dose was administered twice in each patient, 1 month before and 6 months after surgery. After intake of either 100 mg of metoprolol IR or CR tablet serum concentration-time profiles of metoprolol were determined. The endpoint was the ratio of AUCafter/AUCbefore of metoprolol. Results: Twelve patients were included in the study (metoprolol IR: 7; metoprolol CR: 5). After intake of a metoprolol IR tablet major intraindividual and interindividual differences for area under the serum concentration versus time curve (AUC) of metoprolol before and after surgery were observed (range ratio AUC0-10 hours after/AUC0-10 hours before: 0.74-1.98). For metoprolol CR tablets a significant reduction in bioavailability of metoprolol was observed after surgery (range ratio AUC0-24 hours after/AUC0-24 hours before: 0.43-0.77). Conclusion: RYGB may influence the bioavailability of metoprolol from an IR tablet. The magnitude of changes in bioavailability after RYGB requires close monitoring of patients using metoprolol IR tablets and dose adjustment if deemed necessary. RYGB clearly reduces the bioavailability of metoprolol from a CR tablet. After RYGB clinicians may consider to increase the dose according to clinical response

Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

<p>The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.</p>