Gastric bypass surgery linked to alcohol abuse
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Patients who undergo bariatric surgery, particularly Roux-en-Y gastric bypass, may face a higher risk of alcohol abuse and dependency in the second year after the procedure, a University of Pittsburgh study has found.
The observational study involving 1,945 adults who underwent bariatric surgery at 10 U.S. hospitals found that 7.6 percent of the patients had problems with alcohol before surgery but 9.6 percent of the patients ended up with alcohol use disorder, or AUD, two years afterward. There was no increase in alcohol abuse or dependency during the first year after surgery. AUD includes a range of problems with drinking alcohol, from occasional overindulgence to alcoholism.
But the study also found more dramatic results in patients who underwent the Roux-en-Y gastric bypass surgery, which reduces the size of the stomach and bypasses a moderate amount of the small intestine. Among those cases, which accounted for about 70 percent of the total cases in the study, alcohol use disorder rose from 7 percent before surgery to 10.7 percent two years post surgery -- a 53 percent jump.
About half of those with the disorder after the surgery had no problems with alcohol beforehand.
That increase is worrisome even if it represents less than 4 percent of the patients who undergo surgery to reduce obesity, the researchers said. With approximately 150,000 receiving bariatric procedures each year, the 2 percent overall increase in alcohol use disorder for all bariatric procedures represents up to 3,000 people a year who face problems with alcohol in the years following surgery.
The study, to be published in the Journal of the American Medical Association, was placed online Monday to coincide with its presentation during the annual meeting of the American Society of Bariatric and Metabolic Surgery in San Diego.
Project leader Wendy C. King, an epidemiologist with the Pitt Graduate School of Public Health, said the study, the first to show an increase in alcohol use disorder with Roux-en-Y, confirming anecdotal observations doctors specializing in bariatric surgery have noticed for years. "The bottom line, people need to be educated on the potential of Roux-en-Y increased risk and need to talk about the risk and benefits of the health it provides so they can make the best decision," she said.
Why bariatric surgery, particularly Roux-en-Y, can cause problems with alcohol isn't known.
Of the obese adult subjects, all enrolled in a National Institutes of Health assessment of bariatric surgery, 79 percent were female and 87 percent white with a median age of 47. All completed preoperative and postoperative assessments from 2006 to 2011. The Alcohol Use Disorder Identification Test, or AUDIT, developed by the World Health Organization, was used to measure alcohol problems before and after surgery.
Along with the gastric bypass procedure, males, younger patients, smokers, regular alcohol consumers and recreational drug users, those who scored low in a "sense-of-belonging" test, along with people with alcohol problems prior to the surgery, were groups found to have an increased likelihood of alcohol use disorder after surgery, the study found.
Study co-author Anita P. Courcoulas, the chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center, said the study found that the rise in alcohol use disorder was "small but significant," and should be a factor in assessing the risks and benefits of bariatric surgery.
"For surgeons, we need to educate patients prior to surgery, especially those with alcohol-use issues in the past," she said. "They are at higher risk."
First Published June 19, 2012 12:00 am