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RYGB associated with non-alcohol substance use disorder

Researchers have discovered a link between gastric bypass surgery and an increased risk of non-alcohol substance use disorder, according to a study in published in Obesity, and these risks should be considered in long-term postoperative care.

"The current study shows that non-alcohol substance use disorder was 2.5 times more common after gastric bypass surgery compared with controls receiving usual obesity care, but the total number of patients having non-alcohol substance use disorder was overall low” said Professor Per-Arne Svensson, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden and the Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, and corresponding author of the study. “Health care professionals should consider the risk of non-alcohol substance use disorder in the care of patients treated with gastric bypass surgery.”

A previously acknowledged side effect of bariatric surgery is an increased intoxication level after alcohol consumption. It has also been reported that gastric bypass surgery is associated with an increased incidence of alcohol abuse. In recent years, however, studies have shown substances other than alcohol have been over consumed after bariatric surgery.

In the Swedish Obese Subjects (SOS) study, 2,010 patients with obesity who underwent bariatric surgery - 265 patients for gastric bypass, 1,369 with vertical banded gastroplasty and 376 patients with gastric banding. A total of 2,037 matched control individuals received usual obesity care. Participants who had non-alcohol substance use disorders were identified using the International Statistical Classification of Diseases (ICD) from the Swedish National Patient Register (NPR) covering hospital treatment but not primary care.

The study was conducted at 25 public surgical departments and 480 primary health centres throughout Sweden. Participants were between the ages of 37 and 60, and had a BMI of at least 34kg/m2 for males and 38kg/m2 for females. The study included patients from September 1987 to January 2001 with a follow up period of nearly 24 years.

Results revealed that only gastric bypass surgery was associated with increased incidence of non-alcohol substance use disorder compared with control participants. The most common diagnoses were other psychoactive substance-related disorders; sedative, hypnotic or anxiolytic related disorders and opioid related disorders.

In addition, when the groups that had undergone different surgical procedures were compared with each other, no statistical difference in incidence of non-alcohol substance use disorder was detected.

"It is important to acknowledge that the number of affected patients was relatively low, in the single digits," said Dr Jihad Kudsi, a bariatric surgeon and chairman of surgery, Duly Health and Care, Oak Brook, Ill. Kudsi was not associated with the research. "These significant findings further reinforce the recommendations of the American Society for Metabolic and Bariatric Surgery and highlight the critical role of bariatric behavioural health clinicians in the comprehensive evaluation and care of patients both before and after weight-loss surgery. It is noteworthy that a history of past substance abuse or dependence, which has fully remitted, should not be considered a contraindication for weight-loss surgery."

“We conclude that patients treated with gastric bypass have an elevated risk of non-alcohol SUD,” the authors stated. “Pre- and postoperative care of these patients should include assessment of the risk of substance abuse that extends beyond alcohol abuse. In addition, further studies specifically designed to address this risk, which include all currently used surgical procedures, are warranted.”

The study's authors noted that further research to address this risk is warranted.

The outcomes were reported in the paper, ‘Non-alcohol substance use disorder after bariatric surgery in the prospective, controlled Swedish Obese Subjects study’, published in Obesity. To access this paper, please click here


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