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Post-operative alcoholism

Research suggests surgery increases effect of alcohol

The trial compared the effect of sleeve gastrectomy versus gastric bypass on bioavailability of alcohol both three months and one year after their surgery

Preliminary results from a trial in Norway suggest that sleeve gastrectomy leads to patients having a more rapid uptake of alcohol, which also reaches higher concentrations in their blood and is detectable for longer. The research was presented at this year’s European Congress on Obesity in Prague, Czech Republic, by Magnus Strømmen, Centre of Obesity, Department of Surgery, St Olavs University Hospital, Trondheim, Norway.

In this study, the authors set up a trial to compare the effect of sleeve gastrectomy versus gastric bypass on bioavailability of alcohol both three months and one year after their surgery. This first report comes from the three month tests for the first five sleeve gastrectomy patients (three men and two women, mean age 45 years).

Participants, all with a BMI>40, underwent fasting and then had a standardised breakfast one hour prior to alcohol administration. Ethanol (alcohol) dosage was calculated on basis of measured preoperative total body water. Dosage was 0.4 g/kg TBW for women and 0.5 g/kg TBW for men. Both an oral and intravenous test was performed (in random order) on every participant to calculate the bioavailability of ethanol, meaning the fraction of alcohol that reaches systemic circulation. As the liver is central in metabolising alcohol, it was necessary also to perform the intravenous tests to control for eventual changes in liver function due to the surgery or weight loss.

For the oral test, participants consumed vodka 40% diluted with orange juice to a concentration of 20%. For the intravenous test, ethanol 40% was diluted with glucose 5% to a concentration of 5g/100 ml, and administered as infusion over 30 minutes. Blood alcohol content was analysed with a lower detection limit of 2.2mmol/L at a series of time points. This gave the basis for detecting peak blood ethanol concentration (Cmax), time at which Cmax is observed, and the area under curve, which reveals the total ethanol exposure over time.

For the purpose of evaluating the participants’ intoxication, the authors performed neuropsychological tests measuring attention and working memory at the point when alcohol reached maximum levels. These results have not yet been analysed.

However, the data so far shows that three months postoperatively, uptake of alcohol was more rapid, reached higher concentrations and was detectable longer. Relative bio­availability was considerably higher than prior to surgery.

“We believe the main reason is that sleeve gastrectomy leave patients with a reduced gastric surface, which in turn decreases the oxidation of alcohol by enzymes in the stomach,” the authors said. “This trial aims at comparing the magnitude of this effect relative to that of the gastric bypass-procedure. If one of the two surgical procedures show considerably less effect on bioavailability of alcohol, this would provide clinicians better basis for recommending what is the best treatment on an individual level.”

Based upon the existing research as well as the preliminary results from the above trial, the Obesity Clinic at St Olavs University Hospital has incorporated this into its patient education programme under the title: “Learning to drink all over again.”

“Obesity surgery using sleeve gastrectomy seems to increase bioavailability of etha­nol which in turn may enhance its toxicological effects. Patients seeking obesity surgery should be informed about how alcohol uptake and intoxication qualitatively may change after surgery with implications for both safety and possible dependence,” the authors concluded. “Increased awareness among clinicians to detect possible alcohol abuse at an early stage postoperatively, is recommended. This study can contribute to the understanding of earlier findings showing increased rates of death due to accidents and suicide in patients undergoing obesity surgery. For instance, patients who have had obesity surgery should be warned against using common ‘morning after calculators’ for deciding whether or not to drive.”

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