Gouty attacks occur frequently in postoperative gastric bypass patients

doi:10.1016/j.soard.2007.09.012

Surgery for Obesity and Related Diseases

Volume 4, Issue 1, January–February 2008, Pages 11-13

Presented at the 24th Annual Meeting of the American Society for Bariatric Surgery, June 11-16, 2007, San Diego, California

https://doi.org/10.1016/j.soard.2007.09.012 Get rights and content

Abstract

Background

Both obesity and surgery are known risk factors for instigating gouty attacks. We describe the incidence and management of postoperative gouty attacks after bariatric surgery.

Methods

We performed a retrospective, multi-institutional review of 411 consecutive laparoscopic gastric bypass patients and identified all patients with postoperative gouty attacks.

Results

Of the 411 patients reviewed, 21 (5.1%) had had a previous diagnosis of gout. Of these 21 patients, 7 (33.3%) had had an acute attack postoperatively. No patient who had never had a preoperative episode developed gout. In 4 of the 7 (57.1%) patients, the attack was severe enough to require treatment with corticosteroids. Monoarticular attacks occurred in 5 (71.4%) of the 7 patients, and polyarticular attacks occurred in 2 (28.6%). The joints involved included the toes, ankles, and wrists. One patient presented with cervical gout and developed polyarticular gout that required a significant rehabilitation stay.

Conclusion

The morbidity of postoperative gouty attacks in bariatric surgery patients is significant. Patients with a history of gout should given prophylactic treatment and closely monitored.

Section snippets

Methods

In this multi-institutional retrospective study, we reviewed the medical charts of 411 consecutive patients who had undergone standard antecolic, antegastric Roux-en-Y gastric bypass surgery between July 2003 and September 2006 for age, height, weight, body mass index, a documented medical history of gout, and the postoperative course. All patients at both institutions had undergone similar preoperative preparation, including a clear liquid diet with protein supplementation for 4–7 days before

Results

A total of 411 patients were included in this study. Of these 411 patients, 164 (40%) were treated at the Sacred Heart Institute for Surgical Weight Loss and 247 (60%) were treated at the Albert Einstein Healthcare Network. Of these 411 patients, 21 (5.1%) had a previous diagnosis of gout. All 21 of these patients had a history of gout that had required medical treatment. Of the 21 patients, 15 were men (71.4%). Six of the 21 patients were women (4.8%). The mean patient age was 52 years (range

Discussion

The incidence of primary gout has doubled during the past 20 years. Obesity is a documented risk factor for gout because it affects the metabolism and excretion of urate [10]. This increase in the incidence of gout is thought to be related to the increasing prevalence of obesity, which is now at epidemic proportions in the United States. A relationship has been demonstrated between an increasing body mass index and high serum urate levels [11]. Hyperuricemia is necessary for gout to develop.

Conclusion

We found that patients with a preoperative history of gout who undergo laparoscopic gastric bypass are at a significant risk of developing perioperative gouty attacks, despite significant weight loss. The pathogenesis could be multifactorial, related to ongoing weight loss, surgery, dehydration, dietary modification, and renal impairment. Patients thought that their symptoms of gout had worsened during the first 6 months postoperatively, the period in which their weight loss is greatest. Gout

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Original articleGouty attacks occur frequently in postoperative gastric bypass patients

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Ann J Kidney Dis

Rheum Dis Clin North Am

Relationship of uric acid concentration to cardiovascular risk factors in young men: role of obesity and central fat distribution

Int J Obes Relat Metabol Disord

Hyperlipidaemia in hyperuricaemia and gout

Ann Rheum Dis

Epidemiology of gout: is the incidence rising?

J Rheumatol

Diagnosis and management of gout: a rational approach

Postgrad Med J

Pathogenesis of gout

Ann Intern Med

Alteration of urate metabolism by weight reduction

Aust N Z J Med

The pathogenesis of gout

Gout epidemiology and lifestyle choices

Curr Opin Rheumatol

Original article
Gouty attacks occur frequently in postoperative gastric bypass patients