ARTICLE -INCREASED ALCHOHOLISM RATES SEEN AFTER GASTRIC SURGERY

Increased Alcoholism Rates Seen After Gastric Bypass Surgery

 

Gastric Bypass Associated With Higher Alcohol-related Diagnoses Compared With Banding

by David Wild

Chicago—European researchers have found that gastric bypass patients have an increased risk for postoperative alcohol dependence, according to data presented at the 2011 Digestive Disease Week (DDW) meeting (abstract 266). Based on the findings of a retrospective cohort analysis of more than 12,000 bariatric surgery patients, the investigators are calling for clinicians to examine gastric bypass patients for alcohol-related diagnoses.
“The results of this study clearly indicate the need for physicians to screen for alcohol abuse as part of the workup prior to bariatric surgery and to follow patients who undergo this operation carefully for signs of alcohol abuse,” said Craig Fisher, MD, MPH, associate professor in the Department of Surgery, Weill Cornell Medical College of Cornell University, New York City, who was not involved in the study.
According to primary investigator Magdalena Östlund, MD, a researcher in the Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, patients’ increased risk for acute alcohol intoxication and dependence after gastric bypass surgery may stem from greater alcohol absorption in the small intestine and a more immediate spike in blood alcohol levels. Because of this, she said, gastric bypass patients can experience significant impairment after consuming even a single glass of wine, and dependence can lead to weight gain.
Dr. Östlund and colleagues in Sweden and England examined data from 12,277 Swedish gastric bypass and restrictive surgery patients treated between 1980 and 2006 and followed for a mean of 8.9 years postoperatively. They compared data between these patients and 122,770 age- and gender-matched controls who did not undergo bariatric surgery; the researchers did not control for obesity in the matched group.
Compared with controls, bariatric surgery patients had significantly higher rates of psychosis, depression, attempted suicide and alcohol-related diagnoses, such as acute alcohol intoxication and alcohol dependence before surgery. Preoperative rates of these illnesses were similar among patients undergoing restrictive and gastric bypass procedures; however, patients undergoing gastric bypass were 2.3 times more likely than those receiving banding procedures to get inpatient treatment for alcohol-related diagnoses postoperatively (odds ratio, 2.3; 95% confidence interval, 1.7-3.0 for bypass vs. banding). The only other diagnosis that changed in frequency after surgery was psychosis, which decreased in both groups.
“Patients need to be warned of the risks of alcohol consumption following gastric bypass,” Dr. Östlund told DDW attendees.
Dr. Fisher, who moderated the press conference where the data were presented, said the strengths of the study’s design make the findings exceptionally reliable.
“These data are unique in that they capture a population with very complete follow-up information,” said Dr. Fisher. “In the United States, researchers often find it difficult to follow patients continuously, since they sometimes receive initial treatment at one center but go somewhere else for follow-up care. As there are a limited number of bariatric surgery centers in Sweden, the researchers here were able to track all of the patients who underwent surgery in Sweden.”