Impact of Bariatric Surgery on the Pharmacokinetics Parameters of Amoxicillin Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. The effect of bariatric surgery on the direct oral anticoagulant rivaroxaban: the extension study. The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Effect of bariatric surgery on airway response and lung function in obese subjects with asthma. Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals Decreased Levels of Circulating Cancer-Associated Protein Biomarkers Following Bariatric Surgery Changes in Gut Microbiota Composition after Bariatric Surgery: a New Balance to Decode Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Effect of early enteral feeding after upper gastrointestinal surgery. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea
Background Bariatric surgery leads to several anatomo-physiological modifications that may affect pharmacokinetic parameters and consequently alter the therapeutic effect of drugs , such as antibiotics . The pharmacokinetics of oral amoxicillin after Roux-en-Y gastric bypass ( RYGB ) surgery is unknown . Objectives The objective of this study was to evaluate the impact of bariatric surgery on the pharmacokinetics of  amoxicillin . Methods This study was performed as a r and omized , open-label , single-dose clinical trial , with two periods of treatment , in which obese subjects ( n = 8) received an amoxicillin 500 mg capsule orally before and 2 months after the RYGB surgery . The  amoxicillin plasma concentration was determined by liquid chromatography coupled to mass spectrometry ( LC-MS/MS ) . Results After the surgery , the mean weight loss was 17.03 ± 5.51 kg , and mean body mass index ( BMI ) decreased from 46.21 ± 2.82 to 38.82 ± 3.32 kg/m2 . The mean amoxicillin area under the plasma concentration versus time curve from time zero to the time of the last quantifiable concentration ( AUC0–tlast ) increased significantly ( 3.5-fold ) ; the maximum plasma concentration ( Cmax ) increased 2.8-fold after the bariatric surgery . No correlation was found between amoxicillin absorption , BMI , and weight loss percentage . Conclusion The alterations observed in the amoxicillin pharmacokinetics suggest that obese subjects included in this trial had a substantially increase in amoxicillin systemic exposure after RYGB surgery . However , despite this increase , its exposure was lower than the values reported for non-obese volunteers . Trial Registration Identifiers : BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity BACKGROUND Thromboembolic disease is a potentially serious complication in bariatric surgery patients . Direct oral anticoagulants ( DOAC ) have been investigated in orthopedic surgery patients .  DOAC data after bariatric surgery are still limited to the early postsurgical period . Whether postsurgical midterm adaptations due to anatomic and physiologic alterations influence drug pharmacology is currently not known . OBJECTIVE The aim of this study was to investigate the influence of weight loss and type of bariatric surgery on midterm postsurgical pharmacokinetic and pharmacodynamic parameters of rivaroxaban . SETTING University hospital . METHODS In this monocentric study , bariatric patients received a single oral dose of rivaroxaban ( 10 mg ) 6 to 8 months after sleeve gastrectomy ( SG ) or Roux-en-Y-gastric bypass ( RYGB ) . Pharmacokinetic and pharmacodynamic parameters were assessed and compared with prebariatric surgery results . RESULTS We included 6 RYGB and 6 SG patients .  Percent excess weight loss was 71.4 % ( interquartile range 56.4 , 87.9 ) in the SG group and 76.6 % ( 64.5 , 85.7 ) in the RYGB group . Rivaroxaban mean areas under the curve 6 to 8 months after the bariatric procedure ( 922.4 µg × h/L , coefficient of variation 43.2 ) were comparable to those measured preoperatively ( 952.6 µg × h/L , 16.8 ) . There was no relevant difference between the 2 surgical procedure groups . Rivaroxaban led to a decrease of prothrombin fragments F1 + 2 over 12 hours after oral intake confirming in vivo efficacy . CONCLUSIONS Significant weight loss and altered anatomy after RYGB and SG procedures do not appear to affect the pharmacokinetics and pharmacodynamics of prophylactic rivaroxaban . A single dose of Rivaroxaban was well tolerated and considered safe in this trial Background We hypothesized that  laparoscopic adjustable gastric b and ing ( LAGB )  reduces weight and modulates ghrelin production , but largely spares gastrointestinal endocrine function . To examine this hypothesis , we determined plasma concentrations of appetite-control , insulinotropic , and digestive hormones in relation to LAGB . Methods Twenty-four patients undergoing LAGB were prospect ively enrolled .  Body mass index ( BMI ) was measured and blood sample s obtained at baseline and 6 and 12 months post-surgery . Plasma concentrations of leptin , acylated and total ghrelin , pancreatic polypeptide ( PP ) , insulin , glucose-dependent insulinotropic peptide ( GIP ) , active glucagon-like peptide-1 ( GLP-1 ) , gastrin , and pepsinogens I and II were measured using enzyme-linked immunoassays . Results Median percent excess weight loss ( % EWL ) over 12 months was 45.7 % with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery ( p < 0.001 ) . Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery ( p < 0.001 ) . In contrast , plasma levels of acylated and total ghrelin , PP , insulin , GIP , GLP-1 , gastrin , and pepsinogen I did not change in relation to surgery ( p > 0.05 ) . Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months . Conclusions LAGB yielded substantial % EWL and a proportional decrease in plasma leptin . Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss . Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery BACKGROUND Obesity is a risk factor for self-reported asthma and makes asthma management more difficult . The effects of bariatric surgery on asthma in severely obese subjects remain to be documented . METHODS In this prospect i ve study , 12 asthmatic patients with severe obesity were evaluated before , 6 and 12 months after bariatric surgery .  Each had methacholine inhalation tests , measures of expiratory flows and lung volumes , measurements of C-reactive protein and question naires on asthma medication , asthma symptoms and co-morbid conditions . Eleven severely obese patients with asthma ( considered as controls ) underwent the same evaluations . Primary endpoint was airway responsiveness to methacholine and secondary endpoints were lung volumes and markers of systemic inflammation . RESULTS Mean body mass index decreased from 51.2 to 34.4 kg/m(2 ) twelve months post-surgery . Mean PC(20 ) methacholine improved from 0.84 to 6.2 mg/ml ( P < 0.001 ) ; FEV(1 ) , FVC , FRC , FRC/TLC and ERV all improved ( P ≤ 0.006 ) . C-reactive protein decreased from 8.6 to 1.7 mg/L ( P < 0.001 ) Asthma symptoms total score was significantly reduced ( P = 0.03 ) and asthma medication needs decreased , ten patients being able to stop all asthma drugs . No significant changes of these parameters from baseline were observed in asthmatic controls . Improvements in airway responsiveness and lung volumes happened in parallel and correlated with reductions of body mass index ( r = 0.58 , P = 0.049 ) , C-reactive protein levels ( r = -0.74 , P = 0.004 ) . CONCLUSION Airway responsiveness , lung volumes and asthma severity/control markedly improved with weight loss following bariatric surgery in severely obese patients Background Postoperative weight loss and malnutrition are major issues in gastric cancer patients . The concept of oral nutritional supplements ( ONS ) is gaining widespread acceptance . We investigated the effects of ONS administration on postoperative body weight loss in patients with gastric cancer who had undergone total gastrectomy or distal gastrectomy . Methods Patients were r and omized to either the treatment or the control group . In both groups , st and ard surgery for gastric cancer was performed . In the treatment group , intervention with ONS was performed until 12 weeks after discharge . In the control group , patients were fed the usual postoperative diet .  Weight , body composition , quality of life , hematological parameters , and blood chemistry were evaluated . Results We analyzed 113 cases ( 73 distal gastrectomy , 40 total gastrectomy ) .  Weight loss in the ONS group after total gastrectomy was significantly less than that in the control group . Weight loss and skeletal muscle mass loss after distal gastrectomy did not differ significantly between the ONS and control groups . Conclusion This study showed ONS after total gastrectomy to significantly diminish postoperative weight loss AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery ABSTRACT Background : The aim of this study was to examine the relationship between weight loss and resistin , apelin , chemerin , and visfatin after  laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : The study group consisted of 19 patients who were operated on for morbid obesity ( BMI : 48.7 ± 6.6 kg/m2 ) , and 22 healthy , normal-weight ( BMI : 22.9 ± 2.5 kg/m2 ) subjects formed the control group . We obtained blood sample s from the study subjects at three different times : before undergoing surgery and at one month and 6 months after surgery . Blood was obtained once from the control group . Results : Significant weight loss was achieved at one and 6 months after surgery . Plasma levels of apelin , resistin , chemerin , and visfatin were higher in morbidly obese patients compared with the control group . Obesity-related peptides decreased one month and 6 months after surgery . Conclusions : Elevated plasma resistin , apelin , chemerin , and visfatin levels in morbidly obese patients are gradually reduced after weight loss . According to these findings , LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period BACKGROUND & AIMS : Although bariatric surgery is the most effective therapy for obesity , only a small proportion of c and i date s undergo this surgery . Endoscopic sleeve gastroplasty ( ESG ) is a minimally invasive procedure that reduces the size of the gastric reservoir . We investigated its durability and effects on body weight and gastrointestinal function in a prospect i ve study of obese individuals . METHODS : Twenty‐five obese individuals ( 21 female ; mean body mass index , 35.5 ± 2.6 kg/m2 ; mean age , 47.6 ± 10 years ) underwent ESG with endoluminal creation of a sleeve along the gastric lesser curve from September 2012 through March 2015 at the Mayo Clinic in Rochester , Minnesota . Subjects were followed for a median period of 9 months . We measured changes in body weight and recorded adverse events ; patients were assessed by endoscopy after 3 months . Four participants underwent pre‐ESG and post‐ESG analyses to measure solid and liquid gastric emptying , satiation ( meal tolerance ) , and fasting and postpr and ial levels of insulin , glucose , and gut hormones . RESULTS : Subjects had lost 53 % ± 17 % , 56 % ± 23 % , 54 % ± 40 % , and 45 % ± 41 % of excess body weight at 6 , 9 , 12 , and 20 months , respectively , after the procedure ( P < .01 ) . Endoscopy at 3 months showed intact gastroplasty in all subjects . After ESG , physiological analyses of 4 participants showed a decrease by 59 % in caloric consumption to reach maximum fullness ( P = .003 ) , slowing of gastric emptying of solids ( P = .03 ) , and a trend toward increased insulin sensitivity ( P = .06 ) . Three patients had serious adverse events ( a perigastric inflammatory collection , a pulmonary embolism , and a small pneumothorax ) but made full recoveries with no need for surgical interventions . No further serious adverse events occurred after the technique was adjusted . CONCLUSIONS : ESG  delays gastric emptying , induces early satiation , and significantly reduces body weight  . ESG could be an alternative to bariatric surgery for selected patients with obesity . ClincialTrials.gov number : NCT 01682733 Background Epidemiological studies have identified obesity as a major risk factor for cancer in humans , and trials have demonstrated a significant reduction in the incidence of cancer after bariatric surgery . The rapidity of weight loss after bariatric surgery provides an opportunity to identify the molecular changes associated with effective obesity treatment . Indirectly , this may provide some insights into the mechanisms that drive the association between obesity and cancer . We sought to measure circulating cancer-associated proteins before and after laparoscopic sleeve gastrectomy ( LSG ) . Methods We prospect ively enrolled 15 patients undergoing LSG .  Thirty-four plasma protein biomarkers thought to be associated with cancer processes were analyzed at baseline and following successful weight loss at 12 weeks using a multiplex bead-based assay .  Results Mean excess body weight loss was 44 % at 12-week follow-up . After LSG , a significant reduction in circulating plasma levels was observed for half ( 17/34 ) of the proteins assessed : VEGF-A , VEGF-C , VEGF-D , endoglin , PLGF , sFASL , IGFBP-1 , IL-18 , prolactin , EGF , TGFα , sCD40L , IL-18 , TNFα , IL-6 , HB-EGF , and PAI-1 . Nonsignificant decreases were found for the remaining proteins . Conclusions Circulating cancer-related biomarker levels were reduced by surgical weight loss , and this benefit was achieved as early as 3 months after operation . The observed reduction in cancer biomarkers may be related to the reported decrease in cancer incidence following bariatric surgery Recently , the link between obesity and gut microbiota has become a focus for research . This study shed some light on the modification of postoperative gut microbial composition after  bariatric surgery .  A prospect i ve longitudinal study on healthy lean subjects and patients who underwent bariatric surgery ( Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy )  was carried out . Anthropometric and metabolic data , smoking , food preferences data , and stool sample s were collected from lean subjects and from obese patients before and 3 and 6 months after surgery ( T0 , T3 , and T6 , respectively ) . We collected stool sample s from 25 obese patients before surgery and 3 and 6 months thereafter and from 25 normal weight patients . After Roux-en-Y gastric bypass , Yokenella regensburgei ( p < 0.05 ) , Fusobacterium varium ( p < 0.05 ) , Veillonella dispar/atypica ( p < 0.05 ) , and Streptococcus australis/gordonii ( p < 0.05 ) were transiently identified in the gut at T3 . Roux-en-Y gastric bypass patients had a permanent increase in Akkermansia muciniphila ( p < 0.05 ) , which is associated with healthy metabolism , both at T3 and T6 . There were no significant changes in gut microbiota in laparoscopic sleeve gastrectomy patients . In our study , Roux-en-Y gastric bypass induced major microbial differences and greater weight loss compared with laparoscopic sleeve gastrectomy . Analyzing the microbiota composition , a proliferation of potential pathogens and the onset of beneficial bacteria was observed . The effects of these bacteria on human health are still far from clear . Underst and ing the mechanisms of action of these bacteria could be the keystone in developing new therapeutic strategies for obesity Background Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery . For bariatric surgery , increased vomiting/retching is detrimental to surgical anastomosis . The present study evaluated the efficacy of aprepitant ( neurokinin-1 inhibitor ) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery . Methods After institutional review board approval , 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial . On r and om division , the patients received a tablet of aprepitant ( 80 mg ) in group A , or a similar-appearing placebo in group P , an hour prior to surgery . All patients received intravenous ondansetron ( 4 mg ) intraoperatively . Postoperatively , the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min , 1 , 2 , 6 , 24 , 48 , and 72 h. Results Both groups were evenly distributed for age , body mass index , type , and length of surgery . Cumulative incidence of vomiting at 72 h was significantly lower in group A ( 3 % ) compared to group P ( 15 % ; p = 0.021 ) . Odds ratio for vomiting in group P compared to group A was 5.47 times . On Kaplan – Meier plot , time to first vomiting was also significantly delayed in group A ( p = 0.019 ) . A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P ( 42.18 vs. 36.67 % ) . On the other h and , nausea scores were unaffected by aprepitant , and no significant difference between groups was found at any of the measured time points . Conclusions In morbidly obese patients undergoing laparoscopic bariatric surgery , addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting The present study was design ed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance , dietary , and physical activity habits and eating behavior of patients following vertical b and ed gastroplasty ( VBG ) . Thirty severely obese female volunteers were included in the study and they were r and omly assigned to one of two intervention groups : usual care ( UC ) or lifestyle intervention ( LS ) group . Patients were followed for 3 years postoperatively . Outcome measures included weight loss , dietary habits , physical activity level ( PAL ) , and eating behavior changes . Weight was significantly lower in the LS group after 12 months ( 84.4 + /- 3.9 kg vs. 98.4 + /- 4.4 kg , P < 0.05 ) , 24 months ( 83.0 + /- 3.3 vs. 101.9 + /- 5.3 kg , P < 0.05 ) , and 36 months following surgery ( 84.2 + /- 3.3 vs. 102.5 + /- 3.5 kg , P < 0.05 ) . Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing . With regard to eating behavior , the LS group scored significantly better in total Dutch Eating Behavior Question naire ( DEBQ ) , Restraint Eating and External Eating scales at all postoperative time points . Similarly , significant differences were found between the two groups in dietary intake . These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery . The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity BACKGROUND AND AIMS The impact of early enteral nutrition in elective upper gastrointestinal surgery was the focus of this study , with particular reference to its feasibility and benefits . METHOD This prospect i ve study was carried out over 2 years . The study group included 30 patients and the control group had 31 patients . Twenty-two patients in each group underwent truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer and gastric outlet obstruction . Eight patients in the study group and nine in the control group underwent gastrectomy for carcinoma stomach .  A st and ard milk-based diet was initiated 12 hours after surgery through a nasojejunal tube . The patients were monitored for side effects of enteral feeding and postoperative infective complications . Nitrogen balance and nutritional parameters like the body weight , serum albumin , and serum transferrin were measured pre and postoperatively . RESULTS The groups were comparable with respect to age , sex , and preoperative nutritional factors like body weight , serum albumin , and serum transferrin . The return of bowel sounds and passage of flatus took place significantly earlier in the study group ( 1.43 vs. 2.81 days ) . Diarrhoea and abdominal cramps were the significant complications noted in the study group in relation to early enteral feeding . No patient required withdrawal of enteral feeds . They showed a positive nitrogen balance on the fourth postoperative day . The patients in the study group showed significant increase in the serum transferrin level compared with the preoperative level but the serum albumin level was not significantly altered . CONCLUSION Early enteral feeding through the nasojejunal tube following elective upper gastrointestinal surgery is feasible , safe and improves the nutritional status Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation
In the case of the majority of studied drugs , an increased absorption rate was observed early after RYGBP .
The effect on systemic exposure allows for a low degree of extrapolation , including between drugs subjected to the same major metabolic and transporter pathways .
Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery .
This review systematic ally examines the effects of bariatric surgery on drug pharmacokinetics , focusing especially on the mechanisms involved in restricting oral bioavailability .