Article

Increased Admission for Alcohol Dependence After Gastric Bypass Surgery Compared With Restrictive Bariatric Surgery

JAMA SURGERY (Impact Factor: 3.94). 04/2013; 148(4):374-377. DOI: 10.1001/jamasurg.2013.700
Source: PubMed

ABSTRACT

IMPORTANCE We demonstrate that patients who have undergone gastric bypass surgery (GBS) have a higher risk of inpatient care for alcohol dependence than those who have undergone restrictive surgery. This highlights a need for health care providers to be aware of this so that early detection and treatment can be put in place. OBJECTIVE To evaluate inpatient care for alcohol abuse before and after GBS compared with restrictive surgery (vertical banded gastroplasty and gastric banding). DESIGN Retrospective population-based cohort study including all patients who underwent GBS, vertical banded gastroplasty, and gastric banding in Sweden from 1980 through 2006. The relative risk of inpatient care for alcohol abuse was studied before and after surgery. SETTING All hospitals in Sweden performing bariatric surgery. PARTICIPANTS A total of 11 115 patients older than 18 years (mean [SD] age, 40.0 [10.3] years; 77% women) who underwent a primary gastric bypass procedure, vertical banded gastroplasty, and gastric banding during the study period. MAIN OUTCOME MEASURES Inpatient care for alcohol abuse, substance abuse, depression, and attempted suicide. RESULTS Mean follow-up time was 8.6 years. Before surgery, there was no difference in inpatient treatment of alcohol abuse among patients who underwent gastric bypass or a restrictive procedure (incidence rate ratio, 1.1; 95% CI, 0.8-1.4). After surgery, there was a 2-fold increased risk of inpatient care for alcohol abuse among patients who had GBS compared with those who had restrictive surgery (hazard ratio, 2.3; 95% CI, 1.7-3.2). CONCLUSIONS AND RELEVANCE Patients who had undergone GBS had more than double the risk of inpatient care for alcohol abuse postoperatively compared with patients undergoing a restrictive procedure, highlighting a need for healthcare professionals to be aware of this for early detection and treatment.

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    • "A similar pattern in increases of postoperative alcohol consumption was also observed by Hawke et al. (1990). The increased odds of developing alcohol problems among patients who underwent RYGB procedure as compared to those who underwent other types of bariatric surgery procedures (i.e., LAGB), were also reported in three other studies (King et al., 2012; Suzuki et al., 2012; Östlund et al., 2013). Overall, the prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use and patients underwent RYGB surgery as compared to those without. "
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    ABSTRACT: Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients.
    No preview · Article · Jan 2016
    • "Of importance, literature suggests that AUDs may also improve in a subgroup of patients following surgery (Wee et al., 2014). Of the surgical types, RYGB has been associated with greater risk of developing an AUD compared with LAGB in multiple studies (King et al., 2012; Suzuki, Haimovici & Chang, 2012; Conason et al., 2013; Östlund et al., 2013; Svensson et al., 2013). The method of alcohol assessment is highly likely to influence the reported rates of AUDs (Mitchell et al., 2015) and may account for a large portion of the variability in findings noted across studies. "
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    ABSTRACT: Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of ‘addiction transfer’ wherein patients substitute one ‘addiction’ (food) for a new ‘addiction’ (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    No preview · Article · Oct 2015 · European Eating Disorders Review
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    • "Baseline AUD in year 1 did not show statistically significant differences in frequency (7.6% vs. 7.3%; p = 0.98); however, a significant increase in the prevalence of AUD was observed between the first and second years after surgery (7.3% vs. 9.6%, p = 0.01); with greater likelihood AUD increase post-surgery independently related to RYGB, but not to restrictive procedures. A large-scale study from Sweden [13] documented that patients who have undergone RYGB surgery have a twofold-increased risk of inpatient care for alcohol abuse than those who have undergone restrictive bariatric surgery. Kalarchian et al. used a structured clinical interview (n = 207) to diagnose AUD. "
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    ABSTRACT: Objective To describe the clinical phenotype of alcohol use disorder (AUD) treatment-seeking patients with Roux-en-Y Gastric Bypass Surgery (RYGB) history; and to compare it to AUD obese non-RYGB controls. Methods Retrospective study of electronic medical records for all patients 30-60 years treated at the Mayo Clinic Addiction Treatment Program, between June, 2004 and July, 2012. Comparisons were performed with consumption patterns pre-RYGB and at time of treatment; excluding patients with AUD treatments pre-RYGB. Results Forty-one out of 823 patients had a RYGB history (4.9%); 122 controls were selected. Compared to controls, the RYGB group had significantly more females [n = 29 (70.7%) vs. n = 35 (28.7%) p < 0.0001]; and met AUD criteria at a significantly earlier age (19.1 ± 0.4 vs. 25.0 ± 1 years old, p = 0.002). On average, RYGB patients reported resuming alcohol consumption 1.4 ± 0.2 years post-surgery, meeting criteria for AUD at 3.1 ± 0.5 years and seeking treatment at 5.4 ± 0.3 years postoperatively. Pre-surgical drinks per day were significantly fewer compared to post-surgical consumption [2.5 ± 0.4 vs. 8.1 ± 1.3, p = 0.009]. Prior to admission, RYGB patients reported fewer drinking days per week vs. controls (4.7 ± 0.3 vs. 5.5 ± 1.8 days, p = 0.02). Neither RYGB, gender, age nor BMI were associated with differential drinking patterns. Conclusion The results of this study suggest that some patients develop progressive AUD several years following RYGB. This observation has important clinical implications, calling for AUD-preventive measures following RYGB. Further large-scale longitudinal studies are needed to clarify the association between RYGB and AUD onset.
    Full-text · Article · Sep 2014 · Journal of Psychosomatic Research
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