Pitt-led study finds more alcohol abuse among bariatric surgery patients

There was a higher prevalence of alcohol use disorders among patients who underwent bariatric surgery in the second year after surgery and specifically after a specific type of gastric bypass compared with the years immediately before and following surgery, according to a study in the June 20 issue of the Journal of the American Medical Association.

The study, led by Wendy C. King, an epidemiologist at the University of Pittsburgh Graduate School of Public Health, looked at whether the prevalence of alcohol use disorders, including alcohol abuse and alcoholism, changed after bariatric surgery. The study compared reported AUD in the year prior to surgery with the first and second years after surgery.
The study was published online today to coincide with its presentation at the annual meeting of the American Society of Bariatric and Metabolic Surgery in San Diego.

Researchers found that the prevalence of AUD symptoms did not significantly differ from a year before or a year after the surgery. But it was significantly higher in the second postoperative year, jumping from 7.6 percent of all patients before the surgery to 9.6 percent of patients in the second year after surgery.

The study involved 1,945 obese adults -- 79 percent female and 87 percent white with a median age of 47 -- who completed preoperative and postoperative assessments between 2006 and 2011. The primary outcome measure for the study was past year AUD symptoms as determined by the Alcohol Use Disorder Identification Test developed by the World Health Organization.

Researchers also found that males, people of younger age, smokers, regular alcohol consumption, AUD, recreational drug use, lower scores on a measure of a sense of belonging at the preoperative assessment and undergoing Roux-en-Y Gastric Bypass (RYGB) surgery were independently related to an increased likelihood of AUD after surgery.

RYGB, which surgically reduces the size of the stomach and small intestine, accounted for 70 percent of surgeries and doubled the likelihood of postoperative AUD compared with laparoscope adjustable gastric banding.

One researcher in the study, Anita P. Courcoulas, chief of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center, said about 150,000 bariatric procedures are done in the United States each year. Study results would suggest that an additional 2,000 to 3,000 patients a year potentially could face problems with alcohol in the second year after their surgeries.

This is a small but significant increase," Dr. Courcoulas said. "For surgeons, we need to educate patients prior to surgery, especially those with alcohol abuse in the past. They are at higher risk. In the long run, we need to follow patients to look for signs and symptoms.

But the relatively small increase in alcohol abuse "doesn't eliminate the metabolic and health benefits" that bariatric surgery provides people who are obese, she said.

It is the best available method that leads to significant permanent weight loss and resolution of many of health conditions including cardiovascular disease," she said.

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