Gastric Bypass Alcohol Liver Damage


Does Gastric Bypass Surgery Increase Your Risk Of Alcoholism

19 liters of fluid gets pulled from the belly – Ascites in liver failure

Although there are many health benefits to gastric bypass surgery, certain risks need to be considered. Among those risks is the impact of drinking alcohol. Evidence indicates that after the surgery, most people become much more sensitive to the effects of alcohol.3 Some studies reveal that each drink can have double its usual effect, and last up to 50 percent longer.4

So, what is the relationship between gastric bypass and alcohol abuse? Unfortunately, 20 percent5 of people who have had gastric bypass surgery develop alcohol use disorder , which is around triple the rate for the general population.

A 2012 study found that two years after surgery, patients demonstrated a higher rate of alcohol addiction that, in many cases, could be attributed to the gastric bypass.6 A study published in 2017 followed up with more than 2,000 patients within several years of receiving bariatric surgery. More than 20 percent displayed AUD symptoms at some point.7

At Ria, weve seen many patients who develop AUD after bariatric surgery, says John Mendelson, Ria Healths chief medical officer. In many cases this occurs months to years after surgery.

Dumping Syndrome After Gastric Bypass


  • Dumping syndrome happens when food moves too quickly from your stomach into your small intestines
  • The symptoms include nausea, diarrhea, bloating, fainting, anxiety, and weakness
  • You can treat it by making changes to your diet

We have an entire page dedicated to this topic because it is a possible side effect of other bariatric procedures like gastric sleeve surgery and duodenal switch.

The side effects that result from gastric bypass dumping syndrome include bowel movement changes, weakness, dizziness, flushing and warmth, nausea and palpitation immediately or shortly after eating and produced by abnormally rapid emptying of the stomach especially in individualswho have had part of the stomach removed.

While this sounds like a bad thing, many patients view it as a blessing in disguise. The symptoms of dumping syndrome are completely avoidable by eating a proper bariatric diet can you think of a more convincing way to keep you on track? In fact, some patients who do not suffer from dumping syndrome will comment that they wish they did, as dumping removes some of the choice involved in food selections.

See our Dumping Syndrome page for more details.

  • Dehydration is the depletion of your bodily fluids
  • The cause is not drinking enough hydrating fluids
  • You can treat dehydration by increasing the amount of fluids you drink

In severecases of dehydration patients may need to return to the hospital for IV fluids and vitamins.

Sleeve Gastrectomy And Gastric Banding

Recent studies have shown that laparoscopic sleeve gastrectomy is safe and effective, resulting in weight loss somewhere between the rates of laparoscopic RYGB and laparoscopic adjustable gastric banding . Although LSG is a restrictive procedure, the removal of the gastric fundus, the primary site of ghrelin production, appears to have a hormonal effect that enhances weight loss by reducing appetite .

Based on questionnaire survey results from 50 countries, Buchwald et al. reported that 340,768 bariatric surgeries were performed worldwide in 2011 , which included 47% LRYGB, 28% LSG, and 18% LAGB. LSG, an initial bariatric surgery for severely obese patients, is a technique used to lower the rates of complication and surgical death. For these reasons, LSG has increased rapidly worldwide and is predicted to become the most frequently performed bariatric surgery.

Table 2. Effect of restrictive bariatric surgery on NAFLD.

Studies of follow-up biopsies for NAFLD in LSG were not found in the literature review. Karcz et al. reported on the effect on NASH diagnosed at the time of LSG and NASH-related comorbidities using clinical and biological data at 1- and 3-year follow-ups. A significant improvement of AST, ALT, triglyceride, and HDL levels was shown in the 87 NASH patients .

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Bariatric Surgery As A Potential Treatment For Nafld

The current hypothesis for the development of NAFLD is that obesity and insulin resistance increase the release of free fatty acids from adipocytes , and hepatic insulin resistance and hepatic steatosis precede the development of T2DM .

In a recent systematic review, post-operative resolution or improvement of T2DM occurred in 73% of patients . Potential mechanisms of T2DM remission underlying the direct anti-diabetic impact of bariatric surgery include enhanced nutrient stimulation of GLP-1, altered physiology from excluding ingested nutrients from the upper intestine, compromised ghrelin secretion, improved hepatic insulin sensitivity, and improved peripheral insulin sensitivity. The changes in the rate of eating, gastric emptying, intestinal transit time, nutrient absorption, and sensing, as well as bile acid metabolism, may also be implicated . Bariatric surgery, which offers the effects of metabolic surgery, should be considered for T2DM patients having difficulty continuing with medical treatment and a potential for future deterioration and diabetic complications.

The mechanism of how bariatric surgery plays a role as a potential treatment for NAFLD is also complex and not fully understood. Bariatric surgery is likely to have potential benefits in ameliorating the factors such as insulin resistance, lipid profile, inflammation, weight loss, and adipokines that contribute in a marked way to the pathogenesis of NAFLD .

Gastric Bypass And Alcohol Absorption


The anatomy of the digestive tract is significantly altered after gastric bypass. Therefore, the body absorbs alcohol differently and is more sensitive to its effects following surgery.

Before gastric bypass surgery, alcohol digestion begins in the stomach. There, an enzyme called alcohol dehydrogenase begins breaking down alcohol as it sits in the stomach. Food in the stomach holds alcohol there longer, allowing it to break down further before it enters the small intestine, where 80% of alcohol is absorbed into the bloodstream.

After gastric bypass surgery, around 95% of the stomach is bypassed, leaving an egg-size pouch that serves as a new stomach. Therefore, alcohol passes almost immediately from the stomach to the small intestine, where it then moves into the bloodstream. Post-op patients are also instructed not to eat food and drink fluids at the same time, which means its likely that no food will keep alcohol in the stomach.

Spending little to no time in the stomach means very little alcohol is broken down by ADH in the stomach, and more alcohol makes it into the bloodstream in a short amount of time.

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Alcohol And The Gastric Bypass Patient


A 32-year-old man, four months out from gastric bypass surgery, was issued a citation for driving under the influence of alcohol shortly after leaving his brothers wedding reception. According to the patient, he had only consumed one glass of champagne, although his blood alcohol content was above the legal limit to operate a motor vehicle .

A female patient, 50 years of age and one year post-gastric bypass, hit and killed a pedestrian with her automobile after having less than two glasses of wine. When police arrived, she was staggering and slurring her words and was taken into custody. Two hours later, she was still unable to maintain her balance or to speak clearly, causing officials to suspect that she had drunk a bottle or two of wine instead of two glasses.

These findings suggest that gastric bypass alters the absorption and/or metabolism of alcohol in such fashion as to increase alcohol sensitivity. In order to determine how gastric bypass may affect the bodys response to alcohol, we reviewed the process of alcohol absorption and metabolism in the non-surgical and gastric bypass patient. This article includes the findings and, based upon such, provides the healthcare professional suggested guidelines for patient use of alcohol post-surgery.




Why Is There A Connection

One possible reason for this link is that bariatric surgery alters your stomach and affects certain hormones in your body, including ghrelin, leptin, and dopamine.8 These hormones influence hunger, the rewards of eating, and can also influence alcohol consumption. In other words, drinking more after surgery may be related to altered body chemistry and the increased feeling of reward.

Research also shows that, because gastric bypass patients metabolize alcohol differently, they get drunker quicker and take longer to sober up. In a 2007 Stanford study, people who had undergone gastric bypass took an average of 108 minutes to reach a breathalyzer reading of zero after a single glass of wine, versus 72 minutes for the control group.9 Since alcohol has a more powerful effect, it may become more appealing to drink.

Finally, it is always possible that addiction transfer comes into play. If someone is addicted to overeating, they may transfer that tendency to other substances such as alcohol in the process of making a change.

Among gastric bypass patients, other factors that might influence vulnerability to alcohol addiction include being male, younger age, smoking, pre-surgical AUD, and a lower sense of belonging.10 Overall, however, there are still many unanswered questions about gastric bypass and alcohol abuse.

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After Gastric Bypass Alcohol Enters The Bloodstream Rapidly

One danger of gastric bypass and alcohol consumption is that a higher concentration of alcohol ends up in the bloodstream much more quickly than it probably did prior to surgery. In fact, a recent study found that participants who recently had gastric bypass reached a blood alcohol content greater than 0.8 within only 10 minutes of consuming one small dose of alcohol.

At this level of intoxication, symptoms include:

  • Loss of coordination

Alcoholism & Gastric Bypass Surgery


The right diet and eating habits after gastric bypass surgery can improve or eliminate all of the above gastric bypass side effects. See the following 2 pages for more information

Do You Qualify for a Bariatric Procedure?

Patients who qualify for bariatric surgery usually:

  • Are at least 80 lbs overweight
  • Are between 18 and 75 years old
  • Have a history of failed weight loss attempts
  • Thoroughly understand that the procedure is just a tool long-term success requires significant diet and lifestyle changes

The minimum bariatric surgery qualifications include:

  • A body mass index of 40 or more
  • OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others
  • OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure

To calculate your BMI, enter your height and weight into the tool, then click the Calculate BMI button.

Check My Insurance Tool

Bariatric surgery insurance coverage varies by insurance policy:

Individual/Family Plans & Small Group Plans Coverage varies by state coverage is required by the Affordable Care Act in some states

Large Group Plans Coverage depends on whether your employer has chosen to add it to your policy

Medicare and Medicaid Bariatric surgery is covered

If your policy covers it and you meet the qualification requirements, your plan will likely include 4 procedures:

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The Swedish Obese Subjects Study

The SOS study is a non-randomized, matched, prospective, controlled, intervention trial that compares the long-term effects of bariatric surgery and usual care in obese subjects. The SOS study and its inclusion and exclusion criteria have been previously described and they were identical for the two treatment groups. Briefly, from September 1st 1987 to January 31st 2001, a total of 4,047 obese individuals were recruited: 2,010 individuals who selected surgical treatment constituted the bariatric surgery group and a matched control group of 2,037 individuals was enrolled based on 18 matching variables.

The baseline examination took place approximately four weeks before the date of bariatric surgery for both the surgery patients and the matched control individuals. At baseline examination and after 2 and 10 years, anthropometric, clinical and biochemical parameters were measured. Blood samples were obtained in the morning after an overnight fast and analyzed at the Central Laboratory of Sahlgrenska University Hospital .

Characteristics Of Patients With Elevated Fibrosis Risk At Baseline And Subsequent Improvement

To assess characteristics of patients who seemed to benefit more from RYGB surgery in terms of fibrosis reduction, we performed a sub-analysis of patients with a high risk of fibrosis at baseline and compared patients with reduction versus no reduction in fibrosis scores 11.6 years after RYGB surgery. Patients with a fibrosis risk-reduction and the group with persistent elevated risk did not differ in terms of age, sex, BMI, weight loss or T2DM prevalence . An equivalent analysis of the patients with a baseline NFS > 0.675 was omitted due to small sample size .

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Research Helps Explain Heightened Sensitivity To The Effects Of Alcohol Experienced By Bariatric Surgery Patients

University of Illinois at Urbana-Champaign, News Bureau
Research identifies the stomach, not the liver, as the site of alcohol first-pass metabolism in women who underwent sleeve gastrectomy surgery.

While scientists have broadly agreed that a fraction of the alcohol people consume is broken down before it reaches the bloodstream in a process called first-pass metabolism, they have been uncertain whether this process occurs in the stomach or the liver.

In addition to clarifying where FPM occurs, the findings also explain why some patients’ sensitivity to alcohol increases dramatically after bariatric surgery, significantly heightening their risks of alcohol-related disorders.

A team of researchers led by food science and human nutrition professor M. Yanina Pepino at the University of Illinois Urbana-Champaign compared alcohol metabolism in 12 sleeve gastrectomy patients with that of nine women of similar ages, body mass indices and drinking habits who had not undergone weight loss surgery.

Once absorbed, most of the alcohol a person ingests is broken down in the liver by an enzymatic process that is saturable.

That is, the slower the stomach emptied, the more efficient the liver would be in metabolizing alcohol during FPM, she said. If, however, FPM occurred in the stomach, the slower the gastric emptying, the more time the stomach would have to break down the alcohol.

Story Source:

Intraoperative Finding Of Liver Cirrhosis In Bariatric Surgery The Role Of Sleeve Gastrectomy: A Report Of Two Consecutive Cases

Simulation of gastric bypass effects on glucose metabolism and non ...

Miguel A Zapata Martinez, MD, Julio C Gallardo Baez, MD, Ulises Caballero-de la Pena, MD, Marco A Juarez-Parra, MD, David J Orozco-Agüet, MD, Jeronimo Monterrubio-Rodriguez, MD. Hospital Christus Muguerza Sur Universidad de Monterrey


Obesity is a reported risk factor for non-alcoholic steatohepatitis , which is a common cause of cirrhosis. The estimated prevalence of nonalcoholic fatty liver disease ranges from 84%-96% and for NASH 25%-55%. Up to 25% of patients with NASH will progress to liver cirrhosis. Cirrhosis is recognized incidentally in 1.4% of patients undergoing elective bariatric surgery.

Even though the marked improvement in liver fibrosis after laparoscopic Roux-en-Y gastric bypass , concern exists about the inaccessible gastric remnant if variceal bleeding occurs or if endoscopic access to the biliary tree is necessary. Laparoscopic sleeve gastrectomy has demonstrated to be well-tolerated in cirrhotic patients and can be as a risk reduction procedure. However, mortality rates are increased in cirrhotic patients undergoing bariatric surgery from 0.3% to 1.2%.

We present 2 cases of patients scheduled for LRYGB in who the intraoperative finding of a cirrhotic liver change the surgical conduct.

Case report:

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Clinical And Demographic Characteristics And Evaluation Of Nafld After Bariatric Surgery Retrospective Longitudinal Analysis

In a second step of this study, we compared clinical and histopathological findings of obese patients at two timepoints, at the time of bariatric surgery and after the procedure . As shown in Table , 24 of the total patients were women. The median age at the time of the bariatric surgery was 41±9 years-old and the median BMI was 37.90±2.21kg/m2. The median age at the time of the second surgery was 43±9 years-old and the median BMI was 25.69±3.79kg/m2. Ten were ex-smokers. The median time between the liver biopsy collections during the surgeries was 21±22 months, ranging from 3 to 82 months. There were no significant statistical differences regarding age, gender and smoking habit in the evaluated groups. However, there was a statistical difference between these groups regarding BMI . There is no mortality after bariatric surgery in this subgroup of patients. However, there were mild to moderate complications in their follow-up such as incisional hernia gastric ring migration intestinal obstruction anemia , anastomotic ulcers depressive disorder and cholelithiasis . One of these patients presented both incisional hernia and cholelithiasis.

Table 2 Clinical and demographic characteristics of patients at the time and after bariatric surgery and the control group.Figure 3

Triglycerides and cholesterol levels at the time of bariatric surgery and after the procedure. * p0.05 T1 vs. T2. Mann Whitney test and Dunns multiple comparisons test.

Figure 4

Drinking Alcohol After Gastric Bypass

People that get gastric bypass surgery should already know they are not to drink alcohol for the first year after getting the procedure. But many use alcohol as an outlet when food is no longer a way to help with their emotional or psychological problems.

In a study published in the Archives of Surgery and written by Dr. Alexis Conason from St Lukes Roosevelt Hospital Center in New York City, there is about a 50 percent increase in substance abuse in the first year after surgery. There are also trends showing patients have turned to other types of substances, including cigarettes and narcotics.

Alcohol drinks lack any nutrients benefits and are high in calories that may minimize your weight loss success. Avoid alcohol drinks during the six months to a year after the bypass surgery as it causes intoxication and low blood sugar.

During the holidays, this dangerous trend continues, as does the risk for increased drinking. The study shows that as gastric bypass patients attend holiday parties and functions, they are not able to participate in the same eating that other guests are, so they turn to alcoholic beverages. There seems to be an even higher risk for alcohol consumption among the Roux-en-Y gastric bypass patients than other types of weight-loss surgeries, although all types of weight loss surgeries carry some risk.

We strongly recommend that patients do not drink alcohol after gastric bypass surgery.


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