Bypassing sweets for alcohol: alcohol pharmacokinetics and alcohol effects in bariatric patients

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Pepino MY 1
1Washington University in St. Louis, School of Medicine, Missouri, United States of America
Bariatric surgery procedures provide the most successful long term treatment for obesity. Currently, the three most popular bariatric surgeries performed worldwide are the Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopy adjustable gastric banding (LAGB). All three procedures decrease gastric volume, but unlike LAGB, in which the stomach/intestine remain intact, both SG and RYGB remove part of the stomach and RYGB also reroutes the intestine. Despite the numerous health benefits of these procedures, mounting evidence shows an increased risk of alcohol use disorders (AUD) after stomach resection surgeries in patients who had no history of alcoholism before surgery. The precise mechanism(s) underlying this association is uncertain, but we hypothesize it is due to gastric resection surgery-induced changes in both: 1) alcohol pharmacokinetics and 2) gut-brain peptides, which modify brain pathways that play a role in food and alcohol reward (e.g., ghrelin, glucagon-like peptide 1). Changes in both alcohol pharmacokinetics and brain sensitivity to reward could affect the subjective effects of alcohol and increase vulnerability to develop an AUD. In this talk I will review epidemiological findings supporting an increased risk of AUD after gastrectomy surgeries, and will present data of an ongoing study in which we are evaluating the effects of RYGB, SG or LAGB surgery on the pharmacokinetics and subjective effects of ingesting ~ 2 standard drinks. Measuring blood alcohol concentrations (BAC) in arterialized blood samples by using headspace-gas chromatography, we found that unlike LAGB, both RYGB and SG cause marked alterations in the response to alcohol ingestion manifested by a faster and higher peak in BAC. Although the effect of SG on alcohol metabolism is smaller than the effect of RYGB, the peak in BAC achieved after consuming ~2 drinks in both groups of women met the National Institute on Alcohol Abuse and Alcoholism criteria used to define an episode of binge drinking, which is a risk factor for developing AUD. These data underscore the need to make patients aware of the alterations in alcohol metabolism that occur after these bariatric surgeries to help reduce the risk of potential serious consequences of moderate alcohol consumption.

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