Severe Alcohol‐Related Liver Disease Following Bariatric Surgery

Given the potential for more rapid ethanol absorption in patients who have undergone bariatric surgery, we hypothesized that bariatric surgery is associated with risk for more severe alcohol‐related liver disease. Therefore, patients ≥ 18 years with alcohol use disorder (AUD) after bariatric surgery were examined using TriNetX (2010–2024). Propensity score matching (PSM) was used to compare patients with AUD following surgery to those with AUD without surgery. Primary outcomes included the likelihood of developing alcohol‐associated hepatitis, cirrhosis, or any clinical decompensation event. All‐cause mortality was a secondary outcome. Of 2 241 137 patients with AUD, 15 808 patients had AUD following bariatric surgery. Before PSM, patients undergoing surgery were generally older, predominantly female, with a higher body mass index (BMI) than those with AUD without surgery. After PSM, each cohort had 15 808 patients (mean [SD] age, 51 [13] years; 70% women). Patients with AUD following bariatric surgery had increased odds of acute alcohol‐associated hepatitis (OR = 1.67, 95% CI: 1.51–1.85; p < 0.001), alcohol‐associated cirrhosis (OR = 1.49, 95% CI: 1.37–1.52; p < 0.001), liver‐related decompensation events (OR = 1.51, 95% CI: 1.39–1.64; p < 0.001) and all‐cause mortality (OR = 1.13, 95% CI: 1.07–1.20; p < 0.001) than those with AUD without surgery. The data suggest an increased risk of severe alcohol‐related liver disease in patients with AUD subsequent to bariatric surgery.