More than a Case Report? Should Wernicke Encephalopathy After Sleeve Gastrectomy be a Concern?

Excerpt

Weight loss surgery falls into three categories: malabsorptive, restrictive, or mixed. Procedures such as sleeve gastrectomy, Roux-en-Y gastric bypass, or duodenal switch are the most frequently performed [1, 2]. In recent years, sleeve gastrectomy (SG) has become the most standard and popular bariatric procedure. Its frequency is increasing worldwide, representing the majority of bariatric surgeries [1, 3]. Although SG has always been considered a restrictive procedure, hormonal changes have been demonstrated and studied making this procedure more complex than it seems to be. Severe nutritional deficiencies with chronic disability have been recently reported, but long-term data on nutritional and postSG macro and micronutrient deficiencies are limited [4, 5]. One of the newly reported SG-associated vitamin deficiencies is B1 vitamin known as thiamine. Thiamine deficiency causes Wernicke encephalopathy (WE) characterized by severe cognitive and psychotic disorders, confusion, ataxia, and dysfunction of cranial nerves (especially in the oculomotor part) [6]. WE has higher incidence in complicated SG and other malabsorptive bariatric procedures which produce true vomiting rather than regurgitation. Intractable vomiting has been the most important cause of WE postbariatric surgery. Other essential predisposing risk factors are excessive alcohol consumption, rapid postbariatric weight loss, or long-term parenteral nutrition [7]. …