Impaired Alcohol Metabolism after Gastric Bypass Surgery: A Case-Crossover Trial

BACKGROUND: Severe obesity remains the leading public health crisis of the industrialized world, with bariatric surgery the only effective and enduring treatment. Poor psychological adjustment has been occasionally reported postoperatively. In addition, evidence suggests that patients can metabolize alcohol differently after gastric bypass. STUDY DESIGN: Preoperatively and at 3 and 6 months postoperatively, 19 Roux-en-Y gastric bypass (RYGB) patients' breath alcohol content (BAG) was measured every 5 minutes after drinking 5 oz red wine to determine peak BAG and time until sober in a case-crossover design preoperatively and at 6 months postoperatively. RESULTS: Patients reported symptoms experienced when intoxicated and answered a questionnaire of drinking habits. The peak BAG in patients after RYGB was considerably higher at 3 months (0.059%) and 6 months (0.088%) postoperatively than matched preoperative levels (0.024%). Patients also took considerably more time to return to sober at 3 months (61 minutes) and 6 months (88 minutes) than preoperatively (49 minutes). Postoperative intoxication was associated with lower levels of diaphoresis, flushing, and hyperactivity and higher levels of dizziness, warmth, and double vision. Postoperative patients reported drinking considerably less alcohol, fewer preferred beer, and more preferred wine than before surgery. CONCLUSIONS: This is the first study to match preoperative and postoperative alcohol metabolism in gastric bypass patients. Post-RYGB patients have much higher peak BAG after ingesting alcohol and require more time to become sober. Patients who drink alcohol after gastric bypass surgery should exercise caution. (J Am Coll Surg 2011;212:209-214. (C) 2011 by the American College of Surgeons)