Almost 10 percent of
patients undergoing bariatric surgery to combat obesity had symptoms of an
alcohol abuse disorder 2 years after surgery, a large prospective cohort study
showed.
The prevalence of
alcohol abuse and dependence increased from 7.6 percent before surgery to 9.6
percent 2 years after the procedure, as reported online in theJournal of the
American Medical Association.
The overall effect was
driven by patients who underwent Roux-en-Y gastric bypass. In that large
subgroup, the prevalence of alcohol use disorder increased from 7 percent
before surgery to 10.7 percent in the second year after surgery, wrote Wendy C.
King, PhD, of the University of Pittsburgh, and colleagues.
"The results
emphasize the need for a discussion of the risks and benefits of surgery for
each patient," King told MedPage Today.
"In no way does
this study mean that bariatric surgery is bad and people shouldn't have it. It
is simply a study that has identified one potential risk that needs to be
discussed within the context of all the risks and benefits, so that each
patient and clinician together can determine the best treatment option."
The publication
coincided with King's presentation of the data at the American Society of
Metabolic and Bariatric Surgery meeting in San Diego.
Growing experience
with bariatric surgery has demonstrated a low short-term risk of serious
adverse events and evidence of a potential reduction in long-term mortality.
However, anecdotal reports have suggested an increased risk of alcohol use
disorders after surgery.
Few follow-up studies
have examined associations between bariatric surgery and postoperative problem
drinking, according to the journal article. Results have been inconclusive.
Several studies have
suggested that certain bariatric procedures — notably, Roux-en-Y gastric bypass
(RYGB) and sleeve gastrectomy — alter alcohol pharmacokinetics, leading to
increased alcohol sensitivity, authors of the article continued in their review
of the background.
King and colleagues
sought to address some of the limitations of the current knowledge base by
examining the prevalence of alcohol use disorders before and after bariatric
surgery in a large multicenter observational cohort study.
The study included
2,458 patients who attended a preoperative research visit completed within 30
days of scheduled surgery. The study population comprised patients who
underwent RYGB, laparoscopic adjustable gastric banding (LAGB), sleeve
gastrectomy, biliopancreatic diversion with duodenal switch, or banded gastric
bypass.
Alcohol use was
assessed by means of the 10-item Alcohol Use Disorders Identification Test
(AUDIT). At the preoperative interview, investigators explored alcohol use and
related consequences during the 12 months prior to surgery.
The AUDIT has a total
score in the range of 0 to 40, and higher scores reflect increased likelihood
of problem drinking. Subsets of AUDIT items assess hazardous drinking (≥3
drinks per occasion or ≥6 drinks on one occasion), symptoms of alcohol
dependence, and alcohol-related harm. A total score ≥8 suggested symptoms of
alcohol use disorder.
The final analysis
comprised 1,945 patients who completed the preoperative assessment and at least
one of the two follow-up assessments (1 and 2 years after surgery) from 2006 to
2011.
Women accounted for
78.8 percent of the patients, 87 percent of whom were Caucasian. Two-thirds of
the patients were married or living with a partner, 37 percent had a college
degree, and 39.7 percent had some college education.
A majority of the
patients (57.4 percent) had received treatment for a psychiatric or emotional
disorder in the year prior to surgery. The authors found that 2.2 percent of
the patients smoked, 7 percent consumed alcohol at least twice a week, 7.8
percent (of the 1,945 patients) met criteria for an alcohol use disorder, and
4.3 percent had a history of recreational drug use.
The patients had a
median body mass index of 45.8. Most patients (69.9 percent) underwent RYGB
procedures, with LAGB the next most common procedure (25.2 percent).
The preoperative
assessment showed that 7.6 percent of the entire study population had symptoms
of an alcohol use disorder in the 12 months before bariatric surgery, declining
to 7.3 percent during the first year after surgery. The prevalence then
increased by 2.3 percent in the second year after surgery, representing a
statistically significant change from year 1.
The relationship
between RYGB specifically and problem drinking (not seen with other procedures)
led to another analysis, one stratified by the type of surgery. The results
showed an increase of more than 50 percent in the prevalence of alcohol use
disorder in patients who underwent RYGB.
The overall analysis
also showed that 1 in 8 patients reported consuming three or more drinks in a
typical occasion during the second postoperative year, and the same proportion
reported having six or more drinks at least once during the second year after
surgery.
"This level of
drinking after surgery is a concern and something that clinicians need to be
aware of," said King.