ORLANDO — Patients who undergo bariatric surgery show a significantly increased risk for alcohol abuse, highlighting the need for better patient selection and interventions to reduce these risks, according to the results of a medical literature review presented at the World Congress of Gastroenterology at ACG 2017.
“We found that bariatric surgery is associated with an increase in moderate- to high-risk alcohol use, with a new-onset incidence of 8% and increased odds of alcohol abuse after surgery,” Praneet Wander, MD, a gastroenterology fellow at Hofstra Northwell School of Medicine in New York, said during her presentation. “Nineteen percent of patients overall reported drinking problems prior to surgery, and these patients still underwent the procedure.”
While data on the risk for alcohol abuse among bariatric patients are inconsistent, it is known that alcohol is metabolized differently in these patients after surgery, “especially Roux-en-Y gastric bypass,” Wander explained. Alcohol absorption is accelerated in these patients, they show higher maximum blood alcohol concentrations, and require a longer time to eliminate alcohol.
“The reasoning behind this is that there is rapid emptying of liquids from the gastric pouch, which may accelerate absorption of alcohol in the small intestine,” she said. “Also, the stomach, which is the main source of alcohol dehydrogenase is bypassed during these procedures and thus it facilitates rapid absorption of alcohol. There is also undiagnosed depression and substance abuse among patients who undergo bariatric surgery.”
To evaluate the effect of bariatric surgery on alcohol abuse, Wander and colleagues reviewed medical literature published through September 2016, and included 12 prospective and 16 retrospective or cross-sectional cohort studies in their analysis. These studies included a total of 15,714 patients (76.8% women) with an average age ranging from 26.5-50.1 years, and an average follow-up of 2.6 years. Most were Roux-en-Y gastric bypass patients, but some also had laparoscopic gastric banding or other restrictive procedures.
Overall, 8% of patients had new-onset significant alcohol use after undergoing bariatric surgery (pooled event rate, 0.08; 95% CI, 0.07-0.09), and 19% reported significant alcohol use before surgery (pooled event rate, 0.19, 95% CI; 0.12-0.28). Further, 23% of patients had significant alcohol abuse after undergoing bariatric surgery (event rate, 0.23, 95% CI; 0.14-0.34).
The meta-analysis showed that patients had a higher risk for significant alcohol use after bariatric surgery than before (OR = 1.5, 95% CI; 1.07-2.11).
Considering these findings, Wander concluded that better screening is needed for high-risk behaviors and selection of patients for bariatric surgery.
“Also, these patients require close follow-up evaluation for psychiatric illnesses and substance abuse after surgery,” she told Healio Gastroenterology and Liver Disease. – by Adam Leitenberger
Wander P, et al. Abstract 10. Presented at: World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting; Oct. 13-18, 2017; Orlando, FL.
Disclosures: The researchers report no relevant financial disclosures.
Editor's note: This article was updated on October 30 with clarifications from the study author.