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

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/m(2)), 8 women who had RYGB surgery 2.2 +/- 4 years ago (body mass index = 30.0 +/- 5.2 kg/m(2)), and 9 women who were scheduled for bariatric surgery (body mass index = 44.1 +/- 4.0 kg/m(2)). 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. (C) 2018 American Society for Metabolic and Bariatric Surgery. All rights reserved.