Restricted access

Research article

First published online June 9, 2025

Request permissions

Wernicke Encephalopathy after Bariatric Surgery: Single-Center Experience

Edip Akpinar, MD https://orcid.org/0000-0003-1445-8680 [email protected], and Erhan Gök, MDView all authors and affiliations

Volume 20, Issue 4

https://doi.org/10.1089/bari.2024.0059

Abstract
References

Abstract

Background:

Wernicke encephalopathy (WE) is increasingly recognized as a complication following bariatric surgery.

Methods:

We retrospectively evaluated patients who developed WE after bariatric surgery. Surgery was based on the National Institutes of Health criteria, and it was performed laparoscopically. Patients resumed oral intake following a successful leak test. Follow-up examinations were done periodically at 1, 3, 6, 9, and 12 months. Continuous variables are reported as medians with ranges, while discrete variables are presented as frequencies.

Results:

Among 2,267 patients who underwent bariatric surgery, 1,777 (78%) had sleeve gastrectomy, and 490 (22%) had one anastomosis gastric bypass. WE was diagnosed in nine patients (0.4%). The median time to readmission for WE was 2 months (1.8–67). Symptoms included vomiting, nausea, anorexia, ataxia, ophthalmoplegia, diplopia, confusion, and amnesia. All patients received intravenous thiamine. One patient developed Korsakoff’s syndrome and later succumbed to sepsis related to large pressure ulcers. Two patients achieved complete recovery, while six exhibited minor residual memory impairments, with two of them also experiencing mild gait disturbances.

Conclusions:

WE is a serious complication that can occur after bariatric surgery, associated with severe vomiting and rapid weight loss, and can be prevented through thiamine supplementation.

Get full access to this article

View all access and purchase options for this article.

References

1. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med, 2019; 381(25):2440–2450;

2. Gillion V, Demoulin N, Devresse A. Life expectancy after bariatric surgery—The Swedish Obese Subjects Study. N Engl J Med, 2021; 384(1):88;

3. Balsiger BM, Murr MM, Poggio JL, et al. Bariatric surgery. Surgery for weight control in patients with morbid obesity. Med Clin North Am, 2000; 84(2):477–489;

4. Kumbhari V, Cummings DE, Kalloo AN, et al. AGA clinical practice update on evaluation and management of early complications after bariatric/metabolic surgery: Expert review. Clin Gastroenterol Hepatol, 2021; 19(8):1531–1537;

5. Chen L, Chen Y, Yu X, et al. Long-term prevalence of vitamin deficiencies after bariatric surgery: A meta-analysis. Langenbecks Arch Surg, 2024; 409(1):226;

6. Galvin R, Bråthen G, Ivashynka A, et al.; EFNS. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol, 2010; 17(12):1408–1418;

7. ter Borg S, Verlaan S, Hemsworth J, et al. Micronutrient intakes and potential inadequacies of community-dwelling older adults: A systematic review. Br J Nutr, 2015; 113(8):1195–1206;

8. Drenick EJ, Joven CB, Swendseid ME. Occurrence of acute Wernicke’s encephalopathy during prolonged starvation for the treatment of obesity. N Engl J Med, 1966; 274(17):937–939;

9. Yu AT, Gross A, Park K, et al. Wernicke encephalopathy after bariatric surgery: A literature review. Obes Surg, 2023; 33(11):3621–3627;

10. Vellante P, Carnevale A, D’Ovidio C. An autopsy case of misdiagnosed Wernicke’s syndrome after intragastric balloon therapy. Case Rep Gastrointest Med, 2018; 2018:1510850;

11. Caine D, Halliday GM, Kril JJ, et al. Operational criteria for the classification of chronic alcoholics: Identification of Wernicke’s encephalopathy. J Neurol Neurosurg Psychiatry, 1997; 62(1):51–60;

12. Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke–Korsakoff syndrome. Alcohol Alcohol, 2009; 44(2):155–165;

13. Anonymous. Symposium on Surgical Treatment of Morbid Obesity. Proceedings of a consensus conference sponsored by the National Institute of Arthritis, Metabolism, and Digestive Diseases of the National Institutes of Health; held in December 1978 at Bethesda, Maryland. Am J Clin Nutr, 1980; 33(2 Suppl):353–530.

14. Lanska DJ. Chapter 30: Historical aspects of the major neurological vitamin deficiency disorders: The water-soluble B vitamins. Handb Clin Neurol, 2010; 95:445–476;

15. Yamashita N, Aikawa T. Dutch research on beriberi: I. Christiaan Eijkman’s research and evaluation of Kanehiro Takaki’s diet reforms of the Japanese Navy. Nihon Ishigaku Zasshi, 2017; 63(1):3–21.

16. Singleton CK, Martin PR. Molecular mechanisms of thiamine utilization. Curr Mol Med, 2001; 1(2):197–207;

17. Cantu-Weinstein A, Branning R, Alamir M, et al. Diagnosis and treatment of Wernicke’s encephalopathy: A systematic literature review. Gen Hosp Psychiatry, 2024; 87:48–59;

18. Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: A systematic review. Neurology, 2007; 68(11):807–811;

19. Aasheim ET. Wernicke encephalopathy after bariatric surgery: A systematic review. Ann Surg, 2008; 248(5):714–720;

20. Polegato BF, Pereira AG, Azevedo PS, et al. Role of thiamin in health and disease. Nutr Clin Pract, 2019; 34(4):558–564;

21. Guerrini I, Thomson AD, Gurling HM. Molecular genetics of alcohol-related brain damage. Alcohol Alcohol, 2009; 44(2):166–170;

22. Karimi Behnagh A, Eghbali M, Abdolmaleki F, et al. Pre- and post-surgical prevalence of thiamine deficiency in patients undergoing bariatric surgery: A systematic review and meta-analysis. Obes Surg, 2024; 34(2):653–665;

23. Loh Y, Watson WD, Verma A, et al. Acute Wernicke’s encephalopathy following bariatric surgery: Clinical course and MRI correlation. Obes Surg, 2004; 14(1):129–132;

24. Butterworth RF. Effects of thiamine deficiency on brain metabolism: Implications for the pathogenesis of the Wernicke–Korsakoff syndrome. Alcohol Alcohol, 1989; 24(4):271–279;

25. Butterworth RF. Pathophysiology of cerebellar dysfunction in the Wernicke–Korsakoff syndrome. Can J Neurol Sci, 1993;Suppl 3:S123–S6.

26. Novo-Veleiro I, Mateos-Díaz A-M, Rosón-Hernández B, et al.; Wernicke-SEMI Group, Alcohol and Alcoholism Group, Spanish Society of Internal Medicine (SEMI). Treatment variability and its relationships to outcomes among patients with Wernicke’s encephalopathy: A multicenter retrospective study. Drug Alcohol Depend, 2023; 252:110961;

|

You currently have no access to this content. Visit the access options page to authenticate.