Patients with a History of Bariatric Surgery Are 8 Years Younger at Presentation with Severe Alcoholic Hepatitis

Abstract

Purpose Patients with prior bariatric surgery (BS) are at risk to develop alcohol use disorder (AUD) and alcohol-related liver disease (ALD). Severe alcoholic hepatitis (sAH) is one of the most severe manifestations of ALD with a 28-day mortality of 20-50%. The impact of prior BS on patients presenting with sAH was assessed. Methods From 01/2008 to 04/2021, consecutive patients admitted to a tertiary referral center with biopsy-proven sAH were included in a database. Results One hundred fifty-eight sAH patients of which 28 patients had a history of BS (BS group) were identified. Of this BS group, 24 patients underwent a Roux-en-Y gastric bypass (RYGB), 3 a biliopancreatic diversion, 1 an adjustable gastric band, and no patients a sleeve gastrectomy. The proportion of patients with BS increased threefold over time during the study period. Patients in the BS group were significantly younger at diagnosis of sAH (44.3 years vs 52.4 years), were more frequently female, and had a higher body mass index and a higher grade of steatosis on liver biopsy. The correlation between BS and a younger age at diagnosis remained significant in a multivariate regression analysis. There were no differences in disease severity between both groups. Furthermore, there were no differences in corticosteroid response, 28-day, 90-day, or 1-year survival. Conclusion Prior BS is independently associated with a younger age of presentation with sAH, but is not independently associated with a different disease severity or outcome. These findings support the need for early detection of AUD in patients who underwent BS, in particular RYGB. KeywordBariatric surgery; Complications; Epidemiology; Alcoholic hepatitis Key Points • The fraction of sAH patients with prior bariatric surgery (BS) increased over time. • These patients are significantly younger at diagnosis than those without prior BS. • Awareness for alcohol-related liver disease in patients with prior BS is necessary. Lukas Van Melkebeke, Annelotte G.C. Broekhoven, and Tessa Ostyn shared first authorship.

Liver health and the interplay between obesity, alcohol and bariatric surgery

“…The liver decompensation was also more severe in the patients with a prior BS (56). A recent study reported similar data of BS patients presenting at a younger age with acute alcoholic hepatitis (57). In a retrospective observational analysis of obese adults based on insurance claims, women had undergone BS had twofold increased risk of alcoholic cirrhosis and alcohol misuse compared to women without prior surgery (58).…”

Bariatric surgery for non-alcoholic fatty liver disease: Indications and post-operative management

“…Although BS patients were younger at presentation, survival was similar (61). In a retrospective observational analysis of obese adults based on insurance claims, women had undergone BS had twofold increased risk of alcoholic cirrhosis and alcohol misuse compared to women without prior surgery (62).…”

“…Similarly, a recent study reported that a history of BS is increasingly common in patients presenting with acute alcoholic hepatitis. Although BS patients were younger at presentation, survival was similar [ 61 ]. In a retrospective observational analysis of obese adults based on insurance claims, women had undergone BS had twofold increased risk of alcoholic cirrhosis and alcohol misuse compared to women without prior surgery [ 62 ].…”

‘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

“…Bariatric surgery is associated with an increased risk of alcohol-related liver disease (e.g., alcohol hepatitis and cirrhosis) and AUD-related hospitalizations. 3,[19][20][21][22][23] Despite the increasing number of studies on this topic, few qualitative studies exist. Most of these have focused on patient-perceived causes of postoperative AUD.…”

“…In recent years, several studies have also found a higher incidence of AUD‐related diseases after bariatric surgery. Bariatric surgery is associated with an increased risk of alcohol‐related liver disease (e.g., alcohol hepatitis and cirrhosis) and AUD‐related hospitalizations 3,19–23 …”