RNYer visiting for a few minutes...enteric coated

Hey there...I usually post on the RNY Board mostly.  If I posted on the Main Board people may not know what I'm talking about. So since RNY and DS are malabsorption surgeries, do you chew your medicine??  I take an 81 mg aspirin per day (heart)...Enteric coated. 

Just wondering if you do anything different with enteric coated medicines??  Have there been any studies to show there is no difference in how they are taken and absorbed??  Thanks for any info and data.  Brian

With a shortened digestive track many of us are told to avoid enteric coated meds or split the pill into 2 pieces to take them. My hormones come that way and I split the pills in 2 and take 1/2 in the morning and 1/2 at night.

--gina

I tried to look up info about where in the intestines aspirin is absorbed, and the info I found was confusing, and also did not apply directly to people with either gastric bypass or DS. Having said this, I will summarize a couple points

1. as best I could tell, most absorption takes place in the small intestine, not the stomach. I would guess (just a guess!) that this would be even more true for you because so much of your stomach has been bypassed, and very little of your small intestine is bypassed. I didn't find anything about where, specifically, in the small intestine aspirin absorption occurs.
2. We assume that the enteric coating protects the stomach. However, the anti-platelet effect of aspirin has nothing to do with where it is absorbed, so it can still cause stomach bleeding no matter where it's absorbed. Of course, that's why you are taking it, because the anti-platelet effect is what is hopefully also protective of your heart.   The enteric coating is designed to protect the stomach from direct irritation only.
3. For some unknown reason, I'm not able to write anything else without these numbers! The reason NSAIDs (aspirin is an NSAID though not in the same chemical class as ibuprofen and all those others) are contraindicated with gastric bypass is two fold - partly because you have the blind stomach that can't be assessed with standard diagnostic tests, and partly because you have the junction of pouch and small intestine that has exposure of the pouch to small intestine contents and a reduced blood supply, and thus is more susceptible to injury. Please note that I'm NOT suggesting you shouldn't take your aspirin, this is between you and your doctor, and if your heart needs it, you need it, just that in general this is why people with RNY are never supposed to take NSAIDs.
4. I'm attaching an article which is NOT from the medical literature but seemed to explain this issue better than anything else I could find. I would recommend if at all possible discussing this issue with a pharmacist, as they know more about medicine absorption and such than most doctors.
5. http://www.berkeleywellness.com/self-care/over-counter-produ cts/article/enteric-coated-aspirin-safer

Again, sorry about all the numbers! I can't seem to get rid of them.

Larra

Thanks.  Yeah, I'm aware of the NSAID issue.  Below is what I posted on the RNY Board concerning these issues.  Brian

We had talked about this issue over the years...No conclusions, just projections/thoughts.  I'll try, but I don't know if I will be able to find studies on the subject...Not an easy search.  Everybody wants (pays) to get to the top of searches (Google/Yahoo!/Ask), it becomes really hard to find quantifiable information.  I use good quality chewable vitamins.  I think with all my meds (unless told not to by doctor/pharmacist) I will chew and eat with food/milk.  Now as I recall, I would ask many doctors and pharmacists about this subject.  Most/all did not want to guess or project because of liability.   Brian 

I've heard it both ways that some do fine while others need to split them.  We have a lot of situations where mileage may vary, and this is one of them.