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Review
. 2018 Jul;28(7):2060-2068.
doi: 10.1007/s11695-018-3262-4.

Preventing Wernicke Encephalopathy After Bariatric Surgery

Erik Oudman  1   2 , Jan W Wijnia  3   4 , Mirjam van Dam  3   4 , Laser Ulas Biter  5 , Albert Postma  3   4
Affiliations
Review

Preventing Wernicke Encephalopathy After Bariatric Surgery

Erik Oudman et al. Obes Surg. 2018 Jul.

Abstract

Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke's encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation.

Keywords: Bariatric; Clinical nutrition; Dietary; Gastric; Obesity; Thiamine; Wernicke’s encephalopathy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Bariatric procedure case descriptions (n = 118) leading to Wernicke’s encephalopathy (left), gender and age distribution of case descriptions on Wernicke’s encephalopathy after bariatric surgery (right, n = 113)
Fig. 2
Fig. 2
Reported bariatric WE cases by 2-year period (left) and relative reported WE cases by 2-year period compared to general reference information from NHDS and NSAS databases (1993–2006) [23] and ASMBS (2011–2016) [102]. The red dotted line represents missing information
Fig. 3
Fig. 3
Months after bariatric procedure, Wernicke’s encephalopathy was diagnosed per surgical procedure (n = 115)
Fig. 4
Fig. 4
Long-term cognitive outcome related to number of acute symptoms (left), MRI outcome (middle, n = 55), and too low levels of thiamine treatment (right, n = 52)
See this image and copyright information in PMC

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