Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 28 (7), 2060-2068

Preventing Wernicke Encephalopathy After Bariatric Surgery


Preventing Wernicke Encephalopathy After Bariatric Surgery

Erik Oudman et al. Obes Surg.


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.

Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

This article does not contain any studies with human participants or animals performed by the authors.

Informed Consent Statement

Informed Consent statement does not apply.


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)

Similar articles

See all similar articles

Cited by 2 articles


    1. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–752. - PubMed
    1. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev 2009 (2):CD003641. - PubMed
    1. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5. - PubMed
    1. Alqahtani A, Alamri H, Elahmedi M, Mohammed R. Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study. Surg Endosc Other Interv Technol. 2012;26(11):3094–3100. - PubMed
    1. Gadiot RPM, Biter LU, Zengerink HJF, de Vos tot Nederveen Cappel RJ, Elte JWF, Castro Cabezas M, Mannaerts GHH. Laparoscopic sleeve gastrectomy with an extensive posterior mobilization: technique and preliminary results. Obes Surg. 2012;22(2):320–329. - PubMed

MeSH terms