European Journal of Clinical Pharmacology

, Volume 74, Issue 12, pp 1531–1545 | Cite as

Systematic review of drug bioavailability following gastrointestinal surgery

  • Manuela Moreno SantamaríaEmail author
  • José Javier Arenas Villafranca
  • Jimena Abilés
  • Alberto Fernández López
  • Lucia Visiedo Rodas
  • Begoña Tortajada Goitia
  • Pilar Utrilla Navarro



Inter- and intraindividual pharmacokinetics variability in humans affects the way in which drugs act on the body. Gastrointestinal surgery has an impact on this variability and significantly alters the kinetics of drugs in post-surgical patients. The way in which pharmacokinetic profiles are modified depends on the type of operative procedure performed. The extent to which the absorption of different groups of drugs is affected varies according to the site and length of intestinal resections.


A literature search was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Three databases were searched: MEDLINE, Embase, and the Cochrane Library. For each drug, potential changes in absorption were described, including recommendations extracted from the results of the studies and collected according to authors’ criteria as practical conclusions, and grades of recommendation were determined by levels of evidence using the Oxford Centre for Evidence-Based Medicine scale.


Sixty-eight articles were collected during the selection process after the bibliographic search. The main outcomes for 60 drugs from the various studies were classified according to each type of surgery.


Modifications in the digestive tract secondary to gastrointestinal surgery may compromise the bioavailability of drugs. Decreased absorption surface, gastric emptying speed, and gastric pH alteration are factors to be taken into account in the management of pharmacological treatment after surgery. Evidence supported by data in clinical practice is scarce, but after studying the pharmacokinetic profile of some molecules, it is possible to offer recommendations for its adaptation to the patient’s clinical situation.


Gastrointestinal surgery Drug absorption Pharmacokinetics Bioavailability 



We thank the staff of the surgery and pharmacy services at the Costa del Sol Hospital. The present study is part of “Farmacia” PhD research programme being conducted at the University of Granada.

Author contributions

- All authors have made substantial contributions to all of the following:

• Design of the review system.

• Drafting of the article or revising it critically for important intellectual content.

• Final approval of the version to be submitted.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest and that this study was performed in accordance with ethical research guidelines.

Supplementary material

228_2018_2539_MOESM1_ESM.doc (64 kb)
Appendix I (DOC 64.5 kb)
228_2018_2539_MOESM2_ESM.docx (404 kb)
Appendix II (DOCX 404 kb)
228_2018_2539_MOESM3_ESM.doc (128 kb)
Appendix III (DOC 127 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Manuela Moreno Santamaría
    • 1
    Email author return OK on get
  • José Javier Arenas Villafranca
    • 1
  • Jimena Abilés
    • 1
  • Alberto Fernández López
    • 2
  • Lucia Visiedo Rodas
    • 1
  • Begoña Tortajada Goitia
    • 1
  • Pilar Utrilla Navarro
    • 3
  1. 1.Pharmacy and Nutrition DepartmentCosta del Sol HospitalMarbellaSpain
  2. 2.Surgery DepartmentQuirónsalud HospitalPalmonesSpain
  3. 3.Pharmacology DepartmentUniversity of GranadaGranadaSpain

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