ORLANDO (FRONTLINE MEDICAL NEWS) Bariatric surgery significantly linked with increased levels of alcohol use and abuse in a meta-analysis of 28 studies with a total of nearly 16,000 patients.

Following any of several methods of bariatric surgery, patients showed a statistically significant 8% higher rate of new onset alcohol abuse, and a relative 50% increased rate of significant alcohol use, compared with rates before surgery, Prandeet Wander, MD , said at the World Congress of Gastroenterology at ACG 2017.

The findings suggest that, “after bariatric surgery, patients require close follow-up and evaluation for psychiatric illness and substance abuse,” said Dr. Wander, a gastroenterology fellow at North Shore LIJ Hospital in Manhasset, N.Y. In addition, “screening for high-risk behaviors may help with better patient selection” for bariatric surgery, she suggested.

Her meta-analysis identified prospective, retrospective, and cross-sectional studies of alcohol use that included more than 100 bariatric surgery patients and that had follow-up beyond 1 year. Patients could have undergone Roux-en-Y gastric bypass, sleeve gastrectomy, or laparoscopic adjustable gastric banding. Comparator populations had to be either the surgery patients prior to the procedure or the controls matched by age and body mass index.

The 28 included studies enrolled 15,714 patients who averaged 43 years old, with more than three quarters women. Follow-up averaged 2.6 years. The most common surgery was Roux-en-Y, used in 23 studies, followed by banding in 12 studies, and sleeves in 8 studies (some studies used more than one type of surgery).

Nineteen of the studies examined the prevalence of “significant alcohol abuse” following surgery in a total of 4,552 patients, with 23% of patients overall showing this behavior. Five studies, involving 2,698 patients, documented the rate of new-onset alcohol abuse after surgery, with an overall rate of 8% that was statistically significant. All five studies individually showed increased incidence of alcohol abuse, with rates that ranged from 4% to 8%.

The analysis that showed a relative 50% higher rate of “significant” alcohol use after surgery, compared with the same patients before their surgery used data from 11 studies with 3,370 patients. Five of these 11 studies individually showed a statistically significant increase in alcohol use, 1 showed a significant, 34% relative decrease, and the remaining 5 studies did not show statistically significant changes, with 3 studies trending toward an increased rate and two trending toward a decreased rate after surgery.

None of the 28 included studies had a randomized control arm, and the studies collectively ran in six countries, including the United States, and hence involved different societal norms of alcohol use. Changes in alcohol absorption and metabolism following bariatric surgery may play roles in the observed effects, as might undiagnosed depression or substance use by patients who undergo this surgery, Dr. Wander suggested.

SOURCE: Wander P et al. World Congress of Gastroenterology, abstract 10 .


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