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Gastric bypass surgery promotes alcohol abuse reports new study

Robin Wulffson MD's picture
bariatric surgery, gastric bypass, alcohol abuse, alcoholism, weight loss

Bariatric surgery, or weight loss surgery, is performed on morbidly obese patients who are unable to lose weight with diet and exercise programs. A common type of bariatric surgery is Roux-en-Y gastric bypass (RYGB), which reduces the stomach to a small pouch; thus, restricting food intake. As with any major surgical procedure, the operation is associated with short- and long-term risks, including death.

A new study published online on June 18 in the Journal of the American Medical Association (JAMA) by researchers affiliated with the University of Pittsburgh reports that patients who undergo RYGB have a significantly increased risk of becoming an alcoholic.

The authors noted that bariatric surgery is on the increase in the US as a result of the current obesity epidemic. The researchers conducted a prospective cohort study of adults who underwent bariatric surgery at 10 US hospitals. From 2006 through 2011, of 2,458 participants, 1,945 (78.8% female; 87.0% Caucasian; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at one year and/or two years) assessments. Some of the patients had abused alcohol before their surgery; however, approximately, about 50% of patients who developed abused alcohol following the surgery had no history of alcohol abuse.

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Interestingly, the degree of alcohol abuse did not significantly differ from one year before to one year after gastric bypass surgery (year before: 7.6%; year after: 7.3%); however, abuse was significantly higher (9.6%) in the second postoperative year. The following preoperative factors increased the risk of alcohol abuse after bariatric surgery: male sex, younger age, smoking regular alcohol consumption (two or more drinks/week), alcohol abuse, recreational drug use, and lower self-esteem.

The authors concluded that, following a Roux-en-Y gastric bypass procedure, alcohol abuse was greater in the second postoperative year than the year prior to surgery or in the first postoperative year; furthermore, it was associated with male sex and younger age, as well as a number of preoperative variables (smoking, regular alcohol consumption, previous alcohol abuse recreational drug use, and lower interpersonal support). Factors not involved in alcohol abuse included: race, ethnicity, marital status, education, employment status, household income, body mass index, SF-36 physical and mental component scores, Beck Depression Inventory score, binge eating, and treatment for psychiatric or emotional problems.

The authors note that patients contemplating gastric bypass surgery should be apprised of this risk. They note that evidence exists that gastric bypass surgery alters the pharmacokinetics of alcohol. (Pharmacokinetics is the action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion.) Patients who have undergone bypass surgery who receive a standardized quantity of alcohol, reach a higher peak alcohol level than they did before surgery. Furthermore, some studies have reported that these individuals reach a peak alcohol level more quickly after the surgery or take more time to return to a sober state. Thus, they may feel intoxicated more rapidly after ingesting a small amount of alcohol and lose control over continued drinking.

Reference: Journal of the American medical Association

See also: Is laparoscopic gastric bypass surgery the way to go?