{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:46:36Z","timestamp":1782798396698,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Wernicke encephalopathy (WE) is a serious neurological disorder often linked to alcohol use but can also occur under non-alcoholic conditions, particularly following gastrointestinal (GI) procedures. Existing reviews predominantly focus on bariatric surgery, leaving significant gaps regarding other major GI procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to systematically review and synthesize evidence on the incidence, clinical characteristics, diagnostic methods, management strategies, and outcomes of WE in non-alcoholic adults following gastrointestinal procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA-compliant systematic review was conducted. PubMed, Scopus, Web of Science, and Embase were searched for studies published between 2000 and 2025 that reported Wernicke encephalopathy in non-alcoholic adults following gastrointestinal procedures. Two reviewers independently screened and selected studies. Quality assessment was performed using the Newcastle\u2013Ottawa Scale and Joanna Briggs Institute checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The review included 13 studies involving 1,036 patients. Diverse procedures, including bariatric, oncologic, and emergency gastrointestinal surgeries, were associated with WE, with vomiting identified as the most common precipitating factor. The classical triad of confusion, ataxia, and oculomotor dysfunction appeared in only a minority of patients, while most patients presented with atypical features such as cognitive deficits and polyneuropathy. Magnetic resonance imaging demonstrated characteristic changes in the thalami, mammillary bodies, and periaqueductal gray in confirmed cases. Rates of mortality varied considerably across studies, ranging from 0.3% in bariatric cohorts to 40% in oncologic patients. Early intravenous thiamine was associated with favorable outcomes, although dosing protocols varied considerably across studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>WE following gastrointestinal procedures presents significant diagnostic challenges. Prophylactic thiamine supplementation should be strongly considered in high-risk patients, particularly those with malnutrition, prolonged fasting, or persistent vomiting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251164201<\/jats:ext-link>\n                      , PROSPERO CRD420251164201.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1802386","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:37:43Z","timestamp":1782797863000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Wernicke encephalopathy in non-alcoholic patients following gastrointestinal procedures: a systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Hala","family":"Abu-Qasem","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husna Irfan","family":"Thalib","sequence":"additional","affiliation":[{"name":"General Medicine Practice Program, Batterjee Medical College","place":["Jeddah, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab Shoeb","family":"Ghazi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"Tageldin","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Alras","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanin","family":"Faisal","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laiba","family":"Khan","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abderrahman","family":"Ouban","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounzer","family":"Yassin-Kassab","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Tennessee and Erlanger Hospital","place":["Chattanooga, TN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s11065-012-9200-7","article-title":"Wernicke\u2019s encephalopathy: expanding the diagnostic toolbox","volume":"22","author":"Lough","year":"2012","journal-title":"Neuropsychol Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2875","DOI":"10.2147\/NDT.S130078","article-title":"Korsakoff\u2019s syndrome: a critical review","volume":"13","author":"Arts","year":"2017","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/503596","article-title":"MR Imaging findings in alcoholic and nonalcoholic acute Wernicke\u2019s encephalopathy: a review","volume":"2014","author":"Manzo","year":"2014","journal-title":"BioMed Res Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1111\/j.1468-1331.2010.03153.x","article-title":"EFNS Guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy","volume":"17","author":"Galvin","year":"2010","journal-title":"Eur J Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1111\/imj.12522","article-title":"Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders","volume":"44","author":"Latt","year":"2014","journal-title":"Intern Med J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3109\/00207454.2010.544430","article-title":"Wernicke encephalopathy after gastrointestinal surgery for cancer: causes of diagnostic failure or delay","volume":"121","author":"Rufa","year":"2011","journal-title":"Int J Neurosci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/nyas.13919","article-title":"Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs","volume":"1430","author":"Whitfield","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1016\/j.mayocp.2017.02.019","article-title":"Differences between alcoholic and nonalcoholic patients with Wernicke encephalopathy: a multicenter observational study","volume":"92","author":"Chamorro","year":"2017","journal-title":"Mayo Clin Proc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.nut.2008.08.003","article-title":"Wernicke\u2019s syndrome during parenteral feeding: not an unusual complication","volume":"25","author":"Francini-Pesenti","year":"2009","journal-title":"Nutrition"},{"key":"B10","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.psym.2018.01.004","article-title":"Clinical characteristics and outcomes associated with high-dose intravenous thiamine administration in patients with encephalopathy","volume":"59","author":"Nakamura","year":"2018","journal-title":"Psychosomatics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1177\/0004563220939604","article-title":"Don't seek, don't find: the diagnostic challenge of Wernicke\u2019s encephalopathy","volume":"58","author":"Kohnke","year":"2020","journal-title":"Ann Clin Biochem"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1017\/S1478951514001163","article-title":"Palliative treatment of thiamine-related encephalopathy (Wernicke\u2019s encephalopathy) in cancer: a case series and review of the literature","volume":"13","author":"Isenberg-Grzeda","year":"2014","journal-title":"Palliative and Supportive Care"},{"key":"B13","volume-title":"Wernicke Encephalopathy [Internet]","author":"Vasan","year":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.2214\/ajr.155.6.2122685","article-title":"Wernicke encephalopathy: MR findings in five patients","volume":"155","author":"Gallucci","year":"1990","journal-title":"Am J Roentgenol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.5812\/traumamon.17403","article-title":"Imaging-based diagnosis of Wernicke encephalopathy: a case report","volume":"19","author":"Delavar Kasmaei","year":"2014","journal-title":"Trauma Mon"},{"key":"B16","doi-asserted-by":"publisher","first-page":"77","DOI":"10.4143\/crt.2010.42.2.77","article-title":"Wernicke\u2019s encephalopathy in advanced gastric cancer","volume":"42","author":"Jung","year":"2010","journal-title":"Cancer Res Treat"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3621","DOI":"10.1007\/s11695-023-06840-8","article-title":"Wernicke encephalopathy after bariatric surgery: a literature review","volume":"33","author":"Yu","year":"2023","journal-title":"Obes Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.ijscr.2016.01.016","article-title":"Wernicke\u2019s encephalopathy after sleeve gastrectomy: a literature review","volume":"20","author":"Pardo-Aranda","year":"2016","journal-title":"Int J Surg Case Rep"},{"key":"B19","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1212\/01.wnl.0000256812.29648.86","article-title":"Wernicke encephalopathy after obesity surgery: a systematic review","volume":"68","author":"Singh","year":"2007","journal-title":"Neurology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1097\/SLA.0b013e3181884308","article-title":"Wernicke encephalopathy after bariatric surgery: a systematic review","volume":"248","author":"Aasheim","year":"2008","journal-title":"Ann Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/00000441-200202000-00010","article-title":"Wernicke encephalopathy in nonalcoholic patients","volume":"323","author":"Ogershok","year":"2002","journal-title":"Am J Med Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1080\/01658100600817317","article-title":"Neuro-ophthalmic findings in Wernicke\u2019s encephalopathy after gastric bypass surgery","volume":"30","author":"Sullivan","year":"2006","journal-title":"Neuro-Ophthalmology"},{"key":"B24","first-page":"119","article-title":"Neurologic complications of bariatric surgery","volume":"7","author":"Ba","year":"2010","journal-title":"Rev Neurol Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.soard.2014.06.006","article-title":"Claims to the patient insurance after bariatric surgery in Sweden 2000\u20132012","volume":"11","author":"Skogar","year":"2015","journal-title":"Surg Obes Relat Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2843","DOI":"10.1007\/s11695-016-2227-8","article-title":"Rare neurological complications after sleeve gastrectomy","volume":"26","author":"Tabbara","year":"2016","journal-title":"Obes Surg"},{"key":"B27","first-page":"395","article-title":"Wernicke\u2019s encephalopathy due to non-alcoholic gastrointestinal tract disease","volume":"55","author":"Gungor Dogan","year":"2018","journal-title":"Arch Neuropsychiatry"},{"key":"B28","doi-asserted-by":"publisher","first-page":"297","DOI":"10.5152\/TJAR.2018.72687","article-title":"Retrospective evaluation of patients who underwent laparoscopic bariatric surgery","volume":"46","author":"Tuncali","year":"2018","journal-title":"Turk J Anesth Reanim"},{"key":"B29","doi-asserted-by":"publisher","first-page":"4886","DOI":"10.1177\/0300060519870951","article-title":"Nonalcoholic Wernicke\u2019s encephalopathy: a retrospective study of 17 cases","volume":"47","author":"Yin","year":"2019","journal-title":"J Int Med Res"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/j.soard.2020.05.031","article-title":"A series of severe neurologic complications after bariatric surgery in France: the NEUROBAR study","volume":"16","author":"Alligier","year":"2020","journal-title":"Surg Obes Relat Dis"},{"key":"B31","doi-asserted-by":"publisher","first-page":"638","DOI":"10.3390\/jpm14060638","article-title":"The weight of bariatric surgery: Wernicke\u2013korsakoff syndrome after vertical sleeve gastrectomy\u2014a case series","volume":"14","author":"Guti\u00e9rrez-Rey","year":"2024","journal-title":"J Pers Med"},{"key":"B32","first-page":"1","article-title":"Clinical characterization, natural history, and neuroimaging of cerebellar ataxia after abdominal surgery","volume":"83","author":"Procaci","year":"2025","journal-title":"Arq Neuropsiquiatr"},{"key":"B33","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.soard.2025.03.009","article-title":"ASMBS Literature review and clinical guidelines on prevention, diagnosis, and treatment of Wernicke\u2019s encephalopathy and Wernicke-Korsakoff syndrome","volume":"21","author":"Patterson","year":"2025","journal-title":"Surg Obes Relat Dis"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1802386\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:37:44Z","timestamp":1782797864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1802386\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":33,"alternative-id":["10.3389\/fsurg.2026.1802386"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1802386","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"article-number":"1802386"}}