The association between alcoholic hepatitis and bariatric surgery

Alcoholic hepatitis and bariatric surgery

Abstract

Introduction: patients undergoing bariatric surgery should have long-term postoperative followup in order to identify and prevent new addictions, including alcohol consumption. Early detection of this risk is essential. Internists should also consider that these patients have permanent anatomical and physiological modifications with clinical implications throughout their lives.

Case presentation: we present the case of a 51-year-old woman with a history of a Roux-en-Y gastric bypass performed 15 years earlier, coupled with chronic alcohol consumption, who developed mild alcoholic hepatitis. She presented with a complaint of jaundice, fever and abdominal pain. Her tests showed an AST/ALT ratio > 2 and a bilirubin level of 5.7 mg/dL. She improved after discontinuing alcohol consumption. A liver biopsy showed extensive macrovesicular hepatic steatosis and mild inflammation, without necrosis or fibrosis, compatible with mixed hepatic injury (metabolic and alcoholic). Discussion: bariatric surgery modifies the risk of alcohol-induced liver damage. After gastric bypass, the loss of first-pass metabolism mediated by gastric alcohol dehydrogenase, along with neurohormonal changes, favors accelerated alcohol absorption and increases the risk of alcohol use disorder (AUD). Population studies show a 5-10 times greater risk of AUD as well as a higher incidence of hepatitis and alcoholic cirrhosis in patients who undergo this procedure.

Conclusion: we recommend preoperative screening and extended follow-up using tools like the short Alcohol Use Disorders Identification Test (AUDIT-C) and biological markers (gammaglutamyl transferase [GGT], carbohydrate-deficient transferrin [CDT]). This case highlights the need for ongoing liver monitoring, given the potential for accelerated liver damage with even moderate alcohol consumption. (