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/m²), 8 women who had RYGB surgery 2.2 ±.4 years ago (body mass index = 30.0 ± 5.2 kg/m²), and 9 women who were scheduled for bariatric surgery (body mass index = 44.1 ± 4.0 kg/m²). 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.