Bariatric surgery may increase risk for alcohol use disorders

Among patients who underwent bariatric surgery, there was a higher prevalence of alcohol use disorders in the second year after surgery, and specifically after Roux-en-Y gastric bypass, compared with the years immediately before and following surgery, according to a study in the June 20 issue of JAMA. This study is being published early online to coincide with its presentation at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

"As the prevalence of severe obesity increases in the United States, it is becoming increasingly common for health care providers and their patients to consider bariatric surgery, which is the most effective and durable treatment for severe obesity. Although bariatric surgery may reduce long-term mortality, and it carries a low risk of short-term serious adverse outcomes, safety concerns remain. Anecdotal reports suggest that bariatric surgery may increase the risk for alcohol use disorders (AUD; i.e., alcohol abuse and dependence)," according to background information in the article.

The authors add that there is evidence that some bariatric surgical procedures (i.e., Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy) alter the pharmacokinetics of alcohol. "Given a standardized quantity of alcohol, patients reach a higher peak alcohol level after surgery compared with case-controls or their preoperative levels."

Wendy C. King, Ph.D., of the University of Pittsburgh, and colleagues conducted a study to determine whether the prevalence of AUD changed following bariatric surgery, comparing reported AUD in the year prior to surgery with the first and second years after surgery. The prospective study included 2,458 adults who underwent bariatric surgery at 10 U.S. hospitals. Of these participants, 1,945 (78.8 percent female; 87 percent white; median [midpoint] age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011. The primary outcome measure for the study was past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (AUDIT) (indication of alcohol-related harm, alcohol dependence symptoms, or score 8 or greater).

The researchers found that the prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6 percent vs. 7.3 percent), but was significantly higher in the second postoperative year (9.6 percent). Frequency of alcohol consumption and AUD significantly increased in the second postoperative year compared with the year prior to surgery or the first postoperative year.

"More than half (66/106; 62.3 percent) of those reporting AUD at the preoperative assessment continued to have or had recurrent AUD within the first 2 postoperative years," the authors write. "In contrast, 7.9 percent (101/1,283) of participants not reporting AUD at the preoperative assessment had postoperative AUD. Nonetheless, more than half (101/167; 60.5 percent) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment"

The researchers also found that male sex, younger age, smoking, regular alcohol consumption, AUD, recreational drug use, lower score on a measure of a sense of belonging at the preoperative assessment and undergoing a RYGB were independently related to an increased likelihood of AUD after surgery. RYGB accounted for 70 percent of surgeries and doubled the likelihood of postoperative AUD compared with laparoscopic adjustable gastric banding.

The authors note that although the 2 percent increase (7.6 percent to 9.6 percent) in prevalence of AUD from prior to surgery to the 2-year postoperative assessment may seem small, the increase potentially represents more than 2,000 additional people with AUD in the United States each year, with accompanying personal, financial, and societal costs.

"This study has important implications for the care of patients who undergo bariatric surgery. Regardless of alcohol history, patients should be educated about the potential effects of bariatric surgery, in particular RYGB, to increase the risk of AUD. In addition, alcohol screening and, if indicated, referral should be offered as part of routine preoperative and postoperative clinical care. Further research should examine the long-term effect of bariatric surgery on AUD, and the relationship of AUD to postoperative weight control."

Source: JAMA and Archives Journals