The effect of bariatric surgery on gout: a comparative study

doi:10.1016/j.soard.2014.02.025

Surgery for Obesity and Related Diseases

Volume 10, Issue 6, November–December 2014, Pages 1161-1165

https://doi.org/10.1016/j.soard.2014.02.025 Get rights and content

Abstract

Background

Obesity is a risk factor for the development of gout. An increased incidence of early gouty attacks after bariatric surgery has been reported, but the data is sparse. The effect of weight loss surgery on the behavior of gout beyond the immediate postoperative phase remains unclear. The objective of this study was to evaluate the pre- and postoperative frequency and features of gouty attacks in bariatric surgery patients.

Methods

Charts were reviewed to identify patients who had gout before bariatric surgery. Demographic and gout-related parameters were recorded. The comparison group consisted of obese individuals with gout who underwent nonbariatric upper abdominal procedures.

Results

Ninety-nine morbidly obese patients who underwent bariatric surgery had gout. The comparison group consisted of 56 patients. The incidence of early gouty attack in the first month after surgery was significantly higher in the bariatric group than the nonbariatric group (17.5% versus 1.8%, P = .003). In the bariatric group, 23.8% of patients had at least one gouty attack during the 12-month period before surgery, which dropped to 8.0% during postoperative months 1–13 (P = .005). There was no significant difference in the number of gouty attacks in the comparison group before and after surgery (18.2% versus 11.1%, P = .33). There was a significant reduction in uric acid levels 13-months after bariatric surgery compared with baseline values (9.1±2.0 versus 5.6±2.5 mg/dL, P = .007).

Conclusion

The frequency of early postoperative gout attacks after bariatric surgery is significantly higher than that of patients undergoing other procedures. However, the incidence decreases significantly after the first postoperative month up to 1 year.

Section snippets

Methods

Approval for this study was granted by the Cleveland Clinic Institutional Review Board. Using our bariatric database, we identified morbidly obese patients with a diagnosis of active gout who underwent bariatric surgery at our center between January 2004 and December 2012. We defined active gout as the presence of at least 1 documented episode or evidence of medication usage. Obese patients with active gout who underwent upper abdominal surgery at the same institution during the same time were

Results

The prevalence of gout in our bariatric population was 2.6% (99 patients out of 3,808 during the study period). Only 2 patients developed gout de novo after the bariatric procedure. The bariatric surgery group with prior diagnosis of gout had a male-to-female ratio of 3:1, a mean age of 52.1±10.3 years and an average BMI of 49.5±11.9 kg/m². At the time of surgery, there was no significant difference in the baseline characteristics between the bariatric and nonbariatric groups with respect to

Discussion

Gout increased in prevalence in the United States, partly due to the increase in obesity and metabolic syndrome [8]. Approximately 5 million people in the United States have gout, with an estimated 60% increase in prevalence over a 10-year period [9]. Characterized by monosodium urate crystal deposition, gout can lead to severe arthropathies, physical impairment, and decreased quality of life [10]. The underlying cause of gout, hyperuricemia, has been linked to many conditions that are

Conclusion

In conclusion, this retrospective comparative study supports previous data that early postoperative gout flares are more frequent in the bariatric population compared with a nonbariatric surgery group despite a high rate of standard prophylaxis use. It also suggests an important decrease in incidence of long-term attacks, which coincides with significant reductions in uric acid levels. This highlights the importance of careful perioperative screening and management of the bariatric surgery

Disclosures

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

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^☆: This study has been presented at ASMBS Obesity Week 2013, November 11-16, Georgia World Congress, Atlanta, GA.

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Original articleThe effect of bariatric surgery on gout: a comparative study☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Surg Obes Relat Dis

Clin Dermatol

Risk factors for gout and prevention: a systematic review of the literature

Curr Opin Rheumatol

Gout

Curr Opin Rheumatol

Development of acute gouty attack in the morbidly obese population after bariatric surgery

Obes Surg

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Ann Rheum Dis

Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study

Ann Rheum Dis. Epub

Evaluation of the safety and efficacy of sibutramine, orlistat and metformin in the treatment of obesity

Diabetes Obes Metab

Original article
The effect of bariatric surgery on gout: a comparative study☆