Roux-en-Y Gastric Bypass May Increase Risk for De Novo Alcohol-Related Outcomes

Roux-en-Y gastric bypass (RYGB) is associated with an increased risk for de novo alcohol-related outcomes, according to a study published in the Journal of Clinical Gastroenterology.

Bariatric surgery has been associated with an increased risk for problematic alcohol consumption and alcohol use disorders (AUDs) postoperatively. Few studies have evaluated de novo AUDs and other alcohol-related complications or assessed the relationship between type of bariatric surgery and these outcomes.

Therefore, researchers aimed to determine if bariatric surgeries are associated with de novo alcohol-related complications by studying adults undergoing bariatric surgery or cholecystectomy (control group). Patients with an alcohol-related diagnosis within 1 year prior to surgery were excluded. The primary outcome of the study was any alcohol-related diagnosis after surgery.

In total, 24,550 patients underwent RYGB, 7783 underwent sleeve gastrectomy, 16,664 underwent adjustable gastric band surgery, and 238,429 underwent cholecystectomy. Median patient age at baseline was 45 vs 46 years and 21% vs 25% of patients were men in the bariatric surgery vs control groups, respectively. More patients in the bariatric surgery cohort had been previously diagnosed with depression, anxiety, and obesity.

A total of 2.7% (1346) of patients in the bariatric surgery group developed ≥1 alcohol-related diagnosis vs 1.9% (4448) of patients in the control group. Researchers found that RYGB was significantly associated with an increased risk for any de novo alcohol-related diagnosis (adjusted hazard ratio [aHR], 1.51; P <.001), while adjustable gastric band (aHR, 0.55; P <.001) and sleeve gastrectomy (aHR, 0.77; P =.002) had decreased hazards.

In addition, 928 (1.9%) vs 2511 (1.1%) patients developed de novo alcohol abuse and 459 (0.9%) vs 1499 (0.6%) patients developed de novo alcohol dependence in the bariatric surgery vs control groups, respectively. Specifically, RYGB was associated with a 2- to 3-fold higher hazard for alcoholic hepatitis, abuse, and poisoning.

This study was limited by its reliance on International Classification of Disease codes for classification of alcohol-related diagnoses. Additionally, associations between the long-term effects of bariatric surgery on alcohol-related outcomes were not assessed, as median patient follow-up was <3 years. 

“RYGB was associated with higher hazards of developing de novo alcohol-related hepatitis, abuse, and poisoning compared with a control group,” researchers concluded. “As preoperative evaluation for alcohol use, addictive tendencies, and preexisting liver disease (eg, [nonalcoholic fatty liver disease]) is already standard of care, the results of these evaluations could be used to discuss the risks and benefits of each procedure and decide which surgery to perform.”

Reference

Kim HP, Jiang Y, Farrell TM, Peat CM, Hayashi PH, Barritt AS. Roux-en-Y gastric bypass is associated with increased hazard for de novo alcohol-related complications and liver disease. J Clin Gastroenterol. 2022;56(2):181-185. doi: 10.1097/MCG.0000000000001506