RESUMO
OBJECTIVE: To describe alcohol use, alcohol-related harm, and alcohol-related problems preoperatively and up to 8 years following metabolic and bariatric surgery (MBS) in adolescents. BACKGROUND: Risk for alcohol use and alcohol use disorders (AUD) increases post-Roux-en-Y gastric bypass and vertical sleeve gastrectomy in adults. However, data are lacking in adolescents who undergo MBS. METHODS: This study includes 217 adolescents (aged 13-19 y) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy (2007-2011) and reported alcohol use preoperatively and annually postoperatively for up to 8 years. Time to elevated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score, alcohol-related harm, and alcohol-related problems were analyzed with Kaplan-Meier estimates of cumulative incidence. RESULTS: Preoperatively, the median age was 17 years; the median body mass index was 51 kg/m 2 . Alcohol use frequency and average quantity of drinks per drinking day increased postoperatively (2% consumed alcohol 2-4 times/month 6 months versus 24% 8 years postoperatively, P <0.001; 2% consumed≥3 drinks per drinking day 6 months versus 35% 8 years postoperatively, P <0.001). Cumulative incidence of postoperative onset elevated AUDIT-C score, alcohol-related harm, and alcohol-related problems at year 8 were 45% (95% CI:37-53), 43% (95% CI:36-51), and 47% (95% CI:40-55), respectively. CONCLUSIONS: Nearly half of those who underwent MBS as adolescents screened positively for AUD, symptoms of alcohol-related harm, or alcohol-related problems 8 years post-MBS, highlighting the risk for alcohol use and AUD after MBS in adolescents. AUD evaluation and treatment should be integrated into routine long-term care for adolescents undergoing MBS.
Assuntos
Transtornos Relacionados ao Uso de Álcool , Alcoolismo , Cirurgia Bariátrica , Derivação Gástrica , Obesidade Mórbida , Adulto , Humanos , Adolescente , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Alcoolismo/epidemiologia , Alcoolismo/etiologia , Alcoolismo/cirurgia , Cirurgia Bariátrica/efeitos adversos , Derivação Gástrica/efeitos adversos , Gastrectomia/efeitos adversosRESUMO
Alcohol abuse has impacts on public health worldwide. Conservative treatment to achieve abstinence consists of detoxification combined with psychotherapy and the use of drugs, but it is estimated that only half of the individuals achieve long-term abstinence with the available treatments. In this sense, neurosurgery appears as a therapeutic proposal. The present study aimed to gather information about the circuitry related to alcohol use disorder (AUD), to describe possible surgical targets, and to establish whether a surgical approach could be a safe and effective treatment option. A systematic review of the literature was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The 14 selected articles analyze ablative operations, deep brain stimulation (DBS), and a new procedure in which the patient is first submitted to repetitive transcranial magnetic stimulation to evaluate their response, and later an implant is surgically positioned on the evaluated target to obtain more lasting results. The most relevant outcomes were found when the anterior cingulate cortex (ACC) and the nucleus accumbens (NAcc) were used as targets, demonstrating a large reduction in alcohol intake and even its cessation. However, important side effects were observed, such as psychotic symptoms, right frontal venous infarction, seizures after implantation in the ACC and a hypomanic period after DBS in the NAcc, which could be reversed. Due to the lack of studies involving the surgical treatment of AUD, more clinical trials are needed to compare targets, to assess surgical techniques, and to estimate the safety of these techniques.
Assuntos
Estimulação Encefálica Profunda/métodos , Alcoolismo/cirurgia , Estimulação Magnética Transcraniana/métodos , Técnicas de Ablação/reabilitação , Procedimentos Neurocirúrgicos/métodos , Giro do Cíngulo/cirurgia , Núcleo Accumbens/cirurgiaRESUMO
Drug addictions are chronic mental disorders characterized by compulsive drug seeking and drug use, despite their negative consequences. It is a priority to find therapeutic alternatives to prevent relapse, as there are still no treatments that can ensure abstinence. One of the neural systems implicated in the appearance of the states of discomfort that motivate relapse is the interoceptive system, which oversees our internal body states. However, less attention has been given to the peripheral components of the interoceptive system and their role in addictions. Within these pathways, the vagus nerve represents one of the main visceral afferents of the interoceptive system. We hypothesized that the interruption of visceral afferent pathways would decrease the motivational effects of the drug, thereby either decreasing or preventing drug cravings. To test this idea, we used rats of a high-alcohol-drinking line and measured the effect that vagus nerve resection had on the relapse-like alcohol drinking, expressed as the alcohol deprivation effect, a phenomenon that has been linked to addiction-related events such as alcohol cravings. We found that even though vagotomy completely eliminates the effect of alcohol deprivation, it has no impact on water consumption or animal weight. These results give us valuable information about the relationship between the autonomic nervous system and alcohol use disorders and allow us to propose new clinical research that might have translational options.
Assuntos
Alcoolismo/cirurgia , Interocepção/efeitos dos fármacos , Vagotomia , Animais , Comportamento Aditivo/cirurgia , Doença Crônica , Fissura , Etanol/farmacologia , Feminino , Ratos , Recidiva , AutoadministraçãoRESUMO
Através de um inquérito epidemiológico, buscou-se detectar as co-morbidades dos diagnósticos psiquiátricos relacionados ao álcool. Para tanto, investigou-se os atendimentos num Hospital de Urgências Médicas no Setor de Psiquiatria, no período de 1988 a 1991, tendo por objetivo identificar quais as doenças clínicas e outros incidentes que acometem a populaçäo referida. Fizeram parte do levantamento os diagnósticos relacionados ao álcool, conforme CID 9 (291; 303 e 305.0) e os associados à näo pertencentes à psiquiatria. Evidenciou-se no período, 1835 casos com diagnósticos relacionados ao álcool e destes 487 (26,5 por cento) se referiram aos grupos 291-303-305.0, associados à outros näo psiquiátricos. Desse total a maior frequência de casos ocorreu nos grupos 340-349 (Outros transtornos do SNC) e 800-859 (Lesöes e complicaçöes traumáticas) com 80 (16,4 por cento) atendimentos, respectivamente. Observando-se os dados por ano, constata-se que dos diagnósticos relacionados ao álcool (com diagnósticos clínicos associados) o 303 (Síndrome de Dependência Alcoólica) foi que teve maior número de atendimento com 326 (67 por cento) casos, seguido de 291 (Psicose Alcoólica) com 117 (24 por cento) e 305.0 (Alcool) com 44 (9 por cento). No período, tanto o diagnóstico psiquiátrico 303 como o 291, apareceram mais frequentemente associados ao grupo de diagnósticos clínicos 340-349, com 55 (11,2 por cento) e 12 (2.4 por cento) casos, respectivamente e o 305.0 teve o grupo 800-859 com 10 (2 por cento) casos, como o mais frequente.