Department of Medicine, Division of Gastroenterology and Hepatology.
Department of Statistical Science, Duke University, Durham, NC.
J Clin Gastroenterol. 2022 Feb 1;56(2):181-185. doi: 10.1097/MCG.0000000000001506.
The goal of this study was to determine if bariatric surgeries are associated with de novo alcohol-related complications.
Bariatric surgery is associated with an increased risk of alcohol use disorders. The effect of bariatric surgeries on other alcohol-related outcomes, including liver disease, is understudied.
Using the IMS PharMetrics database, we performed a cohort study of adults undergoing bariatric surgery or cholecystectomy, excluding patients with an alcohol-related diagnosis within 1 year before surgery. The primary outcome was any alcohol-related diagnosis after surgery. We fit a multivariable Cox proportional hazards model to determine independent associations between bariatric surgeries [Roux-en-Y gastric bypass (RYGB); adjustable gastric band; sleeve gastrectomy] versus cholecystectomy and the development of de novo alcohol-related outcomes. We further fit complication-specific models for each alcohol-related diagnosis.
RYGB was significantly associated with an increased hazard of any de novo alcohol-related diagnosis [adjusted hazard ratio (AHR)=1.51, 95% confidence interval (CI): 1.40-1.62], while adjustable gastric band (AHR=0.55, 95% CI: 0.48-0.63) and sleeve gastrectomy (AHR=0.77, 95% CI: 0.64-0.91) had decreased hazards. RYGB was associated with a 2- to 3-fold higher hazard for alcoholic hepatitis (AHR=1.98, 95% CI: 1.17-3.33), abuse (AHR=2.05, 95% CI: 1.88-2.24), and poisoning (3.14, 95% CI: 1.80-5.49).
RYGB was associated with higher hazards of developing de novo alcohol-related hepatitis, abuse, and poisoning compared with a control group. Patients without a history of alcohol use disorder should still be counseled on the increased risk of alcohol use and alcohol-related complications, including alcohol-related liver disease, following RYGB, and should be monitored long term for the development of alcohol-related complications.
本研究旨在确定减重手术是否与新发酒精相关并发症相关。
减重手术与酒精使用障碍风险增加相关。减重手术对其他酒精相关结局（包括肝病）的影响研究较少。
我们使用 IMS PharMetrics 数据库，对接受减重手术或胆囊切除术的成年人进行了队列研究，排除了在手术前 1 年内有酒精相关诊断的患者。主要结局是手术后任何与酒精相关的诊断。我们拟合了多变量 Cox 比例风险模型，以确定减重手术（Roux-en-Y 胃旁路术 [RYGB]；可调节胃束带；袖状胃切除术）与胆囊切除术之间与新发酒精相关结局的独立关联。我们进一步为每个酒精相关诊断拟合了并发症特异性模型。
RYGB 与新发任何酒精相关诊断的风险增加显著相关（调整后的危险比 [AHR]=1.51，95%置信区间 [CI]：1.40-1.62），而可调节胃束带（AHR=0.55，95% CI：0.48-0.63）和袖状胃切除术（AHR=0.77，95% CI：0.64-0.91）的风险降低。RYGB 与酒精性肝炎（AHR=1.98，95% CI：1.17-3.33）、滥用（AHR=2.05，95% CI：1.88-2.24）和中毒（AHR=3.14，95% CI：1.80-5.49）的风险增加 2-3 倍相关。
与对照组相比，RYGB 与新发酒精相关肝炎、滥用和中毒的风险增加相关。没有酒精使用障碍史的患者仍应接受有关饮酒和酒精相关并发症风险增加的咨询，包括 RYGB 后酒精性肝病，并应长期监测酒精相关并发症的发生。
