Abstract
ObjectiveTo explore patients’ long-term experiences with drinking alcohol after Roux-n-Y gastric bypass (RYGB) for conceptualizing what may indicate problematic drinking behavior after bariatric surgery.Study DesignThree-center, observational study.Patients546 adult patients undergoing RYGB in the period 2003-2009 in Norway.Main Outcome MeasuresSelf-reported data on drinking behavior and experiences related to alcohol collected 10-15 years after surgery.ResultsOut of the 959 patients undergoing RYGB in the period, 29 were diseased and 546 participated in this follow-up study (58.7%). Focusing on suspicious changes in drinking behavior, 8.8% reported drinking more, 11.5% consumed alcohol at least twice a week, and 10.6% consumed at a minimum of 6 units of alcohol at a frequency of at least once monthly. The nature of hangovers had changed for about a third of the patients, with 21.6% reporting these to feel weaker or absent. Repeated alcoholic blackouts were reported by 11.9%. A subgroup of the patients were categorized as displaying presumed problematic drinking behavior(PPDB). Among the PPDB-men there was a significant association to having had a fall last year (6 (100.0%) PPDB-patients vs. 30 (29.7%) non-PPDB, p<.001). Among the PPDB-women, there was a significant association to having had alcohol problems prior to surgery (7 (70.0%) PPDB-patients vs. 67 (17.7%) non-PPDB, p<.001). Less significant associations to PPDB reported for explorative purposes were lack of patient education (men) (16 (26.2%) PPDB-patients vs. 8 (61.5%) non-PPDB, p=.014); more than 3 months persistent musculoskeletal pain (women) (45 (15.3%) PPDB-patients vs. 29 (24.6%) non-PPDB, p=.026); subjective problems with memory (women) (58 (20.7%) PPDB-patients vs. 10 (9.1%) non-PPDB, p=.006); and, receiving professional help for mental problems last 12 months (women) (29 (22.7%) PPDB-patients vs. 45 (14.7%) non-PPDB, p=.043).ConclusionA subset of patients display drinking behaviors that may be consistent with postsurgical alcohol problems. Screening instruments like AUDIT may not be sufficiently specific to capture several risk behaviors occurring after bariatric surgery.
Highlights
Several studies suggest that the Roux-n-Y gastric bypass (RYGB) is associated to increased risk of developing alcohol problems
Out of the 959 patients in total, 29 patients were diseased and 546 patients chose to participate in a follow-up and thereby were included in the Bariatric Surgery Observation Study (BAROBS) (58.7%)
While some of the questions reflect concepts from the Alcohol Use Disorders Identification Test (AUDIT) used in the screening for alcohol use disorders, other questions mirror our own experiences with the patients after RYGB
Summary
Several studies suggest that the Roux-n-Y gastric bypass (RYGB) is associated to increased risk of developing alcohol problems. The number of patients reporting regular alcohol consumption (drinking ≥ 2 times/week) had doubled [2]. Data from the Swedish Obese Subjects-study suggest that RYGB patients increased their daily alcohol intake after surgery above preoperative levels [3]. Increased ethanol bioavailability means that even a continuation of the preoperative alcohol intake level could result in a considerably higher systemic ethanol exposure after the operation. This represents a pedagogical challenge when preparing patients for life after surgery. The effect RYGB has on alcohol absorption complicates alcohol history taking and case detection for clinicians in the bariatric follow-up programs
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