Patients' perceptions of the mechanisms underlying alcohol use problems after bariatric surgery: A qualitative systematic review

Abstract

Alcohol-related problems increase after bariatric surgery. The objective of this review was to synthesize findings of qualitative studies on patients' perceptions of the mechanisms leading to problematic alcohol consumption after bariatric surgery. This review followed the Joanna Briggs Institute methodology for systematic review of qualitative evidence. A comprehensive search strategy was performed in MEDLINE, PsycInfo, Scopus and Google Scholar. Study selection, data extraction and critical appraisal of included studies were undertaken by two independent reviewers. Confidence in review findings was assessed using the ConQual approach. Four studies were included in this review and led to the development of four synthesized results: (1) persistence or reappearance of psychological problems after bariatric surgery; (2) using alcohol as a coping strategy, sometimes as a replacement for food; (3) changes in the physiological response to alcohol; and (4) importance of increased information about alcohol-related risks and long-term counseling. Confidence in the synthesized results ranged from moderate to low. The results indicated postoperative problematic alcohol consumption is a complex issue, involving psychological and physiological mechanisms.Several recommendations are formulated based on the results obtained. More qualitative and quantitative studies are needed to better understand this phenomenon given the few existing qualitative studies on this topic and some divergent results found between qualitative and previous quantitative research.

‘We're outside the norm again because of the thing that allowed us to be inside the norm’: An interpretative phenomenological analysis of the experience of developing an alcohol use disorder after bariatric surgery

“…[24][25][26][27][28][29] The main etiological factors patients mentioned were psychological problems that persist after surgery, the replacement of food with alcohol as a coping strategy, the increased effects of alcohol, and a lack of information or followup. 30 These studies rarely distinguished results emerging from the discourse of participants who developed new-onset AUD after surgery and patients who relapsed post-surgery. 30 Moreover, they provided little information about the experience of postoperative AUD, what it entails in terms of emotions and cognitions.…”

“…30 These studies rarely distinguished results emerging from the discourse of participants who developed new-onset AUD after surgery and patients who relapsed post-surgery. 30 Moreover, they provided little information about the experience of postoperative AUD, what it entails in terms of emotions and cognitions. One qualitative study did indicate that, among participants with postoperative AUD who talked about whether or not they regretted the operation, most did not regret surgery while a minority expressed regrets or were ambivalent.…”

“…Most of these have focused on patient‐perceived causes of postoperative AUD 24–29 . The main etiological factors patients mentioned were psychological problems that persist after surgery, the replacement of food with alcohol as a coping strategy, the increased effects of alcohol, and a lack of information or follow‐up 30 . These studies rarely distinguished results emerging from the discourse of participants who developed new‐onset AUD after surgery and patients who relapsed post‐surgery 30 .…”