Sleeve gastrectomy surgery: when 2 alcoholic drinks are converted to 4

Abstract

Background: While it is well established that Roux-en-Y gastric bypass (RYGB) causes a rapid and heightened peak blood alcohol concentration (BAC), results from previous studies on the effects of sleeve gastrectomy (SG) on alcohol pharmacokinetics are conflicting. Data from 2 studies found SG did not affect BAC, whereas another study found SG caused a heightened peak BAC after alcohol ingestion. Moreover, these 3 studies estimated BAC from breathalyzers, which might not reliably estimate peak BAC.

Objectives: The aims of this study were to evaluate (1) the effect of SG, relative to RYGB and a presurgery group, on alcohol pharmacokinetics and subjective effects, and (2) whether breathalyzers are reliable in this population.

Setting: Single-center prospective nonrandomized trial.

Methods: We performed alcohol challenge tests in 11 women who had SG surgery 1.9 ± .1 years ago (body mass index = 35.1 ± 6.6 kg/m2), 8 women who had RYGB surgery 2.2 ± .4 years ago (body mass index = 30.0 ± 5.2 kg/m2), and 9 women who were scheduled for bariatric surgery (body mass index = 44.1 ± 4.0 kg/m2). BACs were estimated from breath samples and measured by gas chromatography at various times after consuming approximately 2 standard drinks.

Results: BAC increased faster, peak BAC was approximately 2-fold higher, and feelings of drunkenness were heightened in both SG and RYGB groups relative to the presurgery group (P values<.001). BAC estimated from breath samples underestimated BAC by 27% (standard deviation = 13%) and missed peak BACs postsurgery.

Conclusions: SG, similar to RYGB, causes marked alterations in the response to alcohol ingestion manifested by a faster and higher peak BAC. The breathalyzer is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol.

Keywords: Alcohol; Bariatric surgery; Breathalyzer; Ethanol; Metabolic surgery; Pharmacokinetics; Sleeve gastrectomy.

Conflict of interest statement

Disclosures

The authors have no conflict of interest in relation to this article.

Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Blood alcohol concentrations (BAC) (panel A) and subjective feelings of drunkenness (panel B) after alcohol ingestion (0.5 g/kg FFM, which is equivalent to ~2 standard drinks) in women who had SG surgery (n=11) or RYGB surgery (n= 8) 1–5 years ago, and in non-operated controls (pre-surgery, n=9). For each time point, scores on feelings of drunkenness on the alcohol day were subtracted from scores on the placebo day. *P <.05 sg group vs. both ryg and pre-surgery groups within a time point>†P <.05 RYGB group vs. pre-surgery group within a time point; § P <.05 pre-surgery group vs. both RYGB and SG within a time point; #P <.05 from baseline.Shown in red, the BAC threshold for binge drinking defined by the National Institute on Alcohol Abuse and Alcoholism, which is also the BAC limit for driving in the United States.

Figure 2

BAC estimated from breath samples (BrAC) in women who had SG surgery or RYGB surgery 1–5 years ago, and in non-operated controls (panel A) Area shown in gray, the lag period from beginning of drinking until ~15 min passed from the end of drinking to obtaining the first BrAC. *P <.05 sg group vs. both ryg and pre-surgery groups within a time point>†P <.05 RYGB group vs. pre-surgery group within a time point. Bland-Altman plot (panel B) for comparing BAC measured by GC and BrAC estimated from breath samples including the mean percent difference between the two methods (27%, solid line) and the 95% limits of agreement (dashed lines).