In summary, although RYGB and SG result in different anatomical changes to the gastrointestinal system, both reduce alcohol FPM and can double peak BACs without affecting systemic AER. The findings that SG and RYGB similarly affect alcohol pharmacokinetics align with the results from several (236, 259, 260) but not all (261, 262) studies, suggesting a comparable increase in AUD prevalence following both procedures. Beyond AUD, altered alcohol handling has wider clinical implications: patients with a history of metabolic surgery who are hospitalized for alcohol-associated liver disease (ALD) decompensate earlier and have higher cumulative mortality, despite being, on average, 12 years younger, than hospitalized patients with ALD who have no history of metabolic surgery (263).
