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Alcohol use disorder after bariatric surgery in adolescences

Bariatric patients who underwent metabolic and bariatric surgery as teenagers are at heightened risk for alcohol use, according to the first study to document long-term alcohol use and associated issues in this population. Research led by a team from the Bariatric Surgery Program at Ann & Robert H. Lurie Children's Hospital of Chicago, IL, found that after eight years, nearly half of study participants had alcohol use disorders, symptoms of alcohol-related harm, or alcohol-related problems. The findings were reported in the paper, ‘A Prospective Cohort of Alcohol use and Alcohol-related Problems Before and After Metabolic and Bariatric Surgery in Adolescents’, published in the Annals of Surgery.

Thomas Inge

"The increased alcohol use we found in this study surpasses that expected from others in this age group in the general population," said study author and principal investigator, Dr Thomas Inge, Surgeon-in-Chief and Director of Adolescent Bariatric Surgery Program at Ann & Robert H. Lurie Children's Hospital of Chicago, as well as Professor of Surgery at Northwestern University Feinberg School of Medicine. "We also know the anatomic changes after surgery result in increased sensitivity to alcohol, so that ounce for ounce, greater effects and consequences of alcohol intake are seen after these operations."

The five centre study included 217 participants (aged 13-19 years) who reported alcohol use before metabolic and bariatric surgery and annually following surgery for up to eight years. Time to elevated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score, alcohol-related harm and alcohol-related problems were analysed with Kaplan-Meier estimates of cumulative incidence.

Preoperatively, median age was 17 years; median BMI was 51 kg/m2. Alcohol use frequency and average quantity of drinks per drinking day increased postoperatively (2% consumed alcohol 2-4 times/month six months versus 24% eight years postoperatively, p<0.001; 2% consumed≥3 drinks per drinking day six months versus 35% eight years postoperatively, p<0.001). Cumulative incidence of postoperative onset elevated AUDIT-C score, alcohol-related harm, and alcohol-related problems at year eight were 45% (95% CI:37-53), 43% (95% CI:36-51), and 47% (95% CI:40-55), respectively.

During the postoperative period, Inge said this equated to an eight-fold increase in potential hazardous drinking, five-fold increase in symptoms of alcohol-related harm and 13-fold increase in alcohol related problems.

"The persistent and concerning pattern of alcohol use in the years after surgery emphasises the need to integrate screening, education, and guidance around alcohol use into the routine primary care for adolescents who have had surgery," said explained Inge, who also holds the Lydia J Fredrickson Board Designated Professorship in Pediatric Surgery.

The authors caution that alcohol use disorder evaluation and treatment should be integrated into routine long-term care for adolescents undergoing metabolic and bariatric surgery.


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