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Alcohol abuse

Study warns of alcohol abuse among bariatric patients

Many patients proceeded with surgery despite concerns over their alcohol consumption

Patients undergoing bariatric surgery should undergo a detailed assessment of their alcohol use, according to a paper published in the journal Surgical Endoscopy.

“In a large study of patients seeking bariatric surgery, a substantial minority of patients exhibited problem-drinking behaviour,” write the study authors from Harvard Medical School, Boston. “Moreover, many of these patients proceeded with surgery, suggesting that detailed assessments of alcohol use are necessary in clinical settings.”

The researchers noted that it has been previously hypothesised that alcohol metabolism is altered after bariatric surgery, as several studies have suggested a high prevalence of postoperative problem drinking.

Study

In this study, the authors sought to characterise alcohol use among bariatric patients before surgery and examine whether having high-risk alcohol drinking behaviour was a factor in determining whether patients proceeded with bariatric surgery.

They recruited 653 patients seeking bariatric surgery from May 2008 to November 2010. Alcohol intake and problem-drinking behaviour recorded in detail via phone interview and multivariable models were used to characterise alcohol drinking patterns and to examine the relationship between problem drinking and the likelihood of proceeding with bariatric surgery.

Although the authors acknowledge that there may have been an element of respondent bias in this paper, they note that the respondents were assured that their responses would be confidential and not reported to the clinical team.

Patients’ drinking patterns into classified into several categories based on their responses to the first two questions about their frequency and quantity of alcohol intake within the last 12 months.

At baseline, 29 % were non-drinkers, 55% were social drinkers and 16% were problem drinkers, including 4% who displayed alcohol abuse behaviour. After adjustment, men and younger adults were significantly more likely to be high-risk drinkers. Problem drinkers were as likely as social drinkers to proceed with bariatric surgery.

“Alcohol abuse is very important with respect to bariatric surgery because of addiction concerns since there is increased sensitivity to alcohol due to digestive alterations that promote augmented absorption of alcohol,” the authors write. “In addition, successful weight loss may not be achieved with alcohol abuse due to the high caloric composition of alcohol. Given the addiction concerns, we advise our patients to be extremely cautious and generally avoid alcohol.”

Conclusion

They state that the results demonstrate the importance of adequately assessing alcohol drinking patterns prior to bariatric surgery and of using studies aimed at determining whether WLS has a detrimental effect on alcohol use. Despite recruiting patients from centres which conduct pre-surgical psychiatric and psychological assessments of substance abuse (including alcohol abuse), the study found that patients who met the criteria for “problem drinking” were no less likely to proceed with bariatric surgery.

“Given the high prevalence of disordered and high-risk alcohol use in our study and in the general population, more attention should be paid to preoperative alcohol use,” they conclude.

The authors also recommend that additional studies are required to examine the interrelationships among alcohol use, bariatric surgery, and the outcomes of bariatric surgery.

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