Alcohol use disorder increases after bariatric surgery

Patients were more likely to report symptoms of alcohol use disorder (AUD) two years after bariatric surgery than they were presurgery, a new study found.

The prospective cohort study included about 2,000 patients who underwent bariatric surgery at 10 U.S. hospitals. The prevalence of AUD was determined by the Alcohol Use Disorders Identification Test, administered preoperatively and one year and/or two years after surgery.

The percentage of patients with AUD symptoms one year after surgery was about the same as before surgery (7.3% vs. 7.6%) and the U.S. average (8.5%, or 6.5% if adjusted to match the mostly female study population). However, two years after surgery, the percentage with AUD was significantly higher: 9.6%. This increase was mostly seen among patients who received Roux-en-Y gastric bypass; they had double the risk of alcohol use disorder compared to patients who had laparoscopic adjustable gastric banding.

Several other risk factors for AUD after surgery were also identified: male sex; younger age; smoking, regular alcohol consumption or recreational drug use before surgery; and lower sense of belonging. Preoperative AUD was also a predictor of postoperative AUD, but more than half of patients who had the disorder after surgery did not report it preoperatively. The results were published in the June 20 Journal of the American Medical Association.

The researchers acknowledged that their cutoff for AUD was lower than some commonly used criteria: Patients were considered to have the disorder if they reported at least one symptom of alcohol-related harm or alcohol dependence. The authors also expressed concern about the levels of drinking reported by even patients who didn't have AUD—1 in 6 patients reported alcohol consumption at a potentially hazardous level by year two.

The authors speculated that increased alcohol sensitivity following Roux-en-Y surgery (as well as resumption of heavier drinking) could be responsible for the increase in AUD. Clinicians should educate potential bariatric surgery patients about the risk of AUD and conduct alcohol screening, and if necessary should refer for treatment, they said. The authors also called for longer-term research on AUD in bariatric surgery patients and investigation of the disorder's relationship to postoperative weight control.