Metabolic bariatric surgery, alcohol misuse and liver cirrhosis: a narrative review

Abstract

Bariatric surgery and liver cirrhosis have considerable overlap. Bariatric procedures intend to reduce metabolic dysfunction-associated steatotic liver disease (MASLD); however, these procedures are thought to increase the propensity for alcohol misuse. This may predispose the bariatric surgical patient to a new form of liver insult in the postoperative period. This review explores the complex relationship between obesity and alcohol misuse in the context of the bariatric surgical patient. There is evidence to support the safety of bariatric procedures in compensated cirrhotic patients, with an improvement of liver function and architecture. However, data suggest that after a two-year period, these patients exhibit an increased propensity for alcohol misuse postoperatively, particularly after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures. A paucity of evidence exists with respect to alcohol-induced liver dysfunction, or MASLD and increased alcohol intake (MetALD) in the post-bariatric surgery patient. This review aims to provide an overview of the current evidence and offer recommendations for further robust studies.