Risk for Alcohol Abuse Intensifies After Bariatric Surgery

Damian McNamara

October 18, 2017

ORLANDO — Rates of significant alcohol use escalate after Roux-en-Y surgery, laparoscopic gastric banding, and sleeve gastrectomy procedures, a systematic review and meta-analysis of 28 studies reveals.

"After bariatric surgery, patients require close follow-up and evaluation for mental health issues and substance abuse," said Praneet Wander, MD, a gastroenterology fellow at the North Shore University Hospital in Manhasset, New York.

And the patients who reported drinking problems before surgery "still underwent the procedure," she added, so we also "need better screening for high-risk behaviors and identification of patients for bariatric surgery."

Bariatric surgery is associated with improvement of obesity-related comorbidities, including diabetes and hypertension. "But some data suggest that postbariatric surgery patients may be susceptible to alcohol abuse," Dr Wander said here at the World Congress of Gastroenterology, where the study received the 2017 American College of Gastroenterology Auxiliary Award for trainee research.

Because data in the literature are inconsistent, she and her colleagues searched the MEDLINE and Embase databases for studies of bariatric surgery. They identified 12 prospective and 16 retrospective or cross-sectional studies that involved 15,714 people. Average follow-up was 2.6 years.

Roux-en-Y gastric bypass — the most common procedure — was assessed in 23 studies, laparoscopic gastric banding in 12, and restrictive bariatric procedures in eight.

After bariatric surgery, patients require close follow-up and evaluation for mental health issues and substance abuse.

Overall, 19% of patients reported high-risk drinking before surgery, but "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," Dr Wander reported.

Despite the limitations of this analysis — the inadequate availability of data from randomized, controlled studies and of "good quality" prospective studies in the literature, and the variations in follow-up times — "we think there is a lot to learn from this study," she said.

The association between alcohol use and bariatric surgery could have a physiologic basis. "Alcohol is metabolized differently after bariatric surgery, especially after Roux-en-Y bypass," Dr Wander explained.

The absorption of alcohol in the small intestine could be accelerated by the rapid emptying of liquids from the gastric pouch. "We see there is accelerated alcohol absorption, higher maximum alcohol concentration in the blood, and it takes a long time to eliminate alcohol after these procedures," she pointed out.

However, other factors could also play a role. "There is also undiagnosed depression and substance abuse among patients who undergo bariatric surgery," she said.

High Divorce Rate After Surgery

Changes in relationships after bariatric surgery could also play a role, said David Johnson, MD, from the Eastern Virginia Medical School in Norfolk, who is editor of Medscape Gastroenterology.

"There is a very high divorce rate after bariatric surgery," he told Medscape Medical News. "The marital discord might explain why some of these people fall off the wagon."

"After bariatric surgery, there can be a lot of body image changes. And it becomes a functional change that not only impacts them, but their spouses, too," Dr Johnson explained. "So some of this may be related. They may turn to alcohol based on dissatisfaction with their life. That to me sounds like a fertile area for exploration."

The bariatric surgery program at his institution features a comprehensive marital counseling arm.

"Clearly, we recognize that after bariatric surgery, there are a number of things that happen," said Dr Johnson. Bariatric patients can experience nutritional deficiencies and vitamin and mineral defects, so require "lifelong monitoring and lifelong vitamin and mineral supplements. There can also be issues that develop related to motility and bacterial overgrowth."

"What this study highlights is the proclivity for the increased development of another problem, and it's alcohol related," he added.

World Congress of Gastroenterology 2017: Abstract 10. Presented October 16, 2017.

Dr Wander and Dr Johnson have disclosed no relevant financial relationships.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter


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