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World J Gastrointest Surg. Mar 27, 2024; 16(3): 650-657
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.650
Alcohol associated liver disease and bariatric surgery: Current perspectives and future directions
Katherine M Cooper, Alessandro Colletta, Nicholas Hebda, Deepika Devuni
Katherine M Cooper, Alessandro Colletta, Nicholas Hebda, Deepika Devuni, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, United States
Deepika Devuni, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01655, United States
Author contributions: Cooper KM conceptualized this review article; Cooper KM, Colletta A, Hebda N, and Devuni D wrote the original draft, reviewed and edited the final draft and gave final approval; Devuni D provided supervision for the writing of this manuscript.
Conflict-of-interest statement: Deepika Devuni has received grant funding from Sequana Medical for a clinical trial unrelated to the present work and grant funding from the NIAAA for research unrelated to this work. All other authors have no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katherine M Cooper, MD, Doctor, Department of Medicine, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA 01655, United States. katherine.cooper@umassmed.edu
Received: November 23, 2023
Peer-review started: November 23, 2023
First decision: January 24, 2024
Revised: January 27, 2024
Accepted: February 26, 2024
Article in press: February 26, 2024
Published online: March 27, 2024
Processing time: 120 Days and 8 Hours
Abstract

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity. However, bariatric surgery has also been linked to increased alcohol use with up to 30% of these patients developing alcohol use disorder (AUD). The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic, metabolic, and neurohumoral changes associated with post-surgical anatomy. These patients are at increased risk of alcohol associated liver disease and, in some cases, require liver transplantation. In this article, we provide a scoping review of epidemiology, pathophysiology, and clinical outcomes of alcohol-related health conditions after bariatric surgery.

Keywords: Obesity medicine; Alcohol use disorder; Roux-en-Y gastric bypass; Vertical sleeve gastrectomy; Liver transplant; Simultaneous liver transplant and bariatric surgery

Core Tip: Bariatric surgery improves obesity related health co-morbidities but also increases the risk of developing alcohol related health problems. Up to 33% of bariatric surgery patients develop an alcohol use disorder (AUD) with peak onset 2 years after surgery and up to 5% develop alcohol associated liver disease (ALD) and cirrhosis. Further research is needed to develop clinical recommendations for AUD screening and to define risk factors for chronic ALD after bariatric surgery.