Prevalence of Alcohol Use Disorder Symptoms Increased after Bariatric Surgery

Bariatric surgery can alter alcohol pharmacokinetics, and there have been anecdotal reports that patients are at higher risk for alcohol use disorders (AUDs) after such surgery. In a prospective cohort of 2458 adults undergoing bariatric surgery, 1945 completed the Alcohol Use Disorders Identification Test (AUDIT) preoperatively (“pre-op”) and again 1 and 2 years later (“post-op”). An AUD was defined as scoring ≥8 on the AUDIT.

• Frequency of drinking, though not number of drinks on a typical drinking day, increased 2 years post-op.

• Although hazardous consumption (>2 drinks on a typical drinking day or >5 on a single occasion) decreased from 20% to 13% in the first post-op year, it rose to 17% in the second post-op year.

• The prevalence of AUD increased from 3% pre-op to 6% 2 years later.

• Of 1283 patients with no pre-op AUD, 8% had an AUD post-op.

• Of 167 patients with post-op AUD, 61% did not have an AUD pre-op.

Comments:

Alcohol use disorders increased after bariatric surgery in this cohort, and most of those affected had no prior (recent) AUD. If anything, the bias from loss to follow-up and selection might strengthen the conclusion (with heavier drinkers not being included in analyses). Interestingly, consumption amounts did not increase even as AUD symptoms doubled, a counterintuitive finding since consumption and AUD are usually correlated, and since people who experience alcohol effects at lower amounts are less likely to develop problems. It may be that more frequent use with more rapid absorption leads to harmful consequences. In any case, results suggest that informing patients of the potential risk pre-op and assessing drinking and consequences post-op is a good idea.

Richard Saitz MD, MPH

Reference:

King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516–2525.