Impact of bariatric surgery on alcohol‐use disorder and alcohol‐related liver disease: A retrospective study

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BACKGROUND AND AIMS: Increased risk of alcohol dependence is recognised following bariatric surgery. Modified gastrointestinal anatomy and neurohormonal profiles lead to altered alcohol metabolism, peak blood alcohol concentrations and enhanced reward circuits and cravings. For patients with metabolic associated fatty liver disease, bariatric surgery has been shown to reduce liver fibrosis; however, the impact of bariatric surgery on alcohol consumption and consequent liver fibrosis has not been well-characterised using validated measures. This study examined the changes in alcohol consumption patterns, alcohol dependence and validated liver fibrosis measures before and after bariatric surgery. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study assessing patients seeking treatment for alcohol problems with a history of gastric sleeve (GS) or Roux-en-Y Gastric Bypass (RYGB) in a quaternary hospital in Brisbane, Australia. MEASUREMENTS: Validated measures of alcohol dependence [Alcohol Use Disorders Identification Test (AUDIT) and brief Michigan Alcohol Screening Test (bMAST)] and non-invasive liver fibrosis (FIB4 and APRI) were compared pre- and post-surgery. FINDINGS: . Metabolic co-morbidities were less frequent post-surgery. Pre-surgery, the mean AUDIT score was 10.2 ± 8.9, with 9 patients having scores indicative of alcohol dependence. Mean AUDIT increased statistically significantly post-surgery (18.1, standard deviation ±11.4; P < 0.001) with 29 patients meeting criteria for alcohol dependence. AUDIT components relating to both consumption (volume, frequency) and harmful consequences of alcohol increased following surgery. Despite surgery lowering metabolic liver fibrosis risk, worsened liver fibrosis was observed [mean FIB4 (0.98 ± 1.8) and APRI (0.41 ± 0.83) increased; P < 0.05]. CONCLUSION: Within a cohort of adults seeking treatment for alcohol problems, increases in alcohol consumption and alcohol-related harm were observed following bariatric surgery. Despite improvement in risk factors for metabolic-associated fatty liver disease after surgery, non-invasive markers for hepatic fibrosis worsened, likely in the setting of harmful alcohol intake and associated liver injury. This supports the role of bariatric surgery pre-operative assessment and post-operative follow-up to identify and manage alcohol-related problems and associated liver disease risk.

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