Bariatric Surgery Is a Safe and Effective Option for Patients with Inflammatory Bowel Diseases: A Case Series and Systematic Review of the Literature

Abstract

Background: Questions remain regarding both the safety and efficacy of bariatric surgery in patients with inflammatory bowel diseases (IBD), including the effects of bariatric surgery on the course of disease. We report a case series from a tertiary care IBD referral center and review the existing literature regarding the safety and efficacy of bariatric surgery in IBD patients. Objectives: Examine the safety and efficacy of bariatric surgery in IBD patients. Explore possible effects of weight loss on postoperative IBD course. Method: We performed a retrospective review of patients at our center undergoing bariatric surgery with a concurrent IBD diagnosis, collecting baseline characteristics, surgery type, and postoperative course (including IBD outcomes and weight loss). Data from these patients were combined with available data from the existing literature to calculate standardized means with standard error, variance, and confidence intervals (CI). Results: Data from 13 patients who had undergone bariatric surgery at our facility were combined with data from 8 other studies to create a study population of 101 patients. Of these, 61 had Crohn’s disease, 37 ulcerative colitis, and 3 IBD-unspecified, with a mean preoperative BMI of 44.2 (95% CI 42.9–45.7). Following surgery, a mean excess weight loss of 68.4% was demonstrated (95% CI, 65.7–71.2). Of the 101 patients, 22 experienced early and 20 experienced late postoperative complications. Postoperatively, 10 patients experienced a flare of IBD, 20 remained in remission, and 7 patients were able to discontinue immunosuppressive therapy. Conclusions: Based on available studies, bariatric surgery appears to be both an effective and safe option for weight loss in patients with IBD.

Safety of bariatric surgery in patients with inflammatory bowel disease: A systematic review and meta‐analysis

“…Based on the inclusion/exclusion criteria, 14 observational studies were finalized for analysis (Figure 1). 11,17‐29 All studies were published after 2013. Of the included studies, nine were published as full manuscripts 11,17‐24 and five were published as abstracts 25‐29 .…”

“… 11,17‐29 All studies were published after 2013. Of the included studies, nine were published as full manuscripts 11,17‐24 and five were published as abstracts 25‐29 . One study each originated from the Netherlands 17 and Israel, 22 while the remaining 12 were from United States 11,18‐21,23‐29 .…”

“…Nine studies reported data regarding treatment for patients with IBD 11,17,18,20‐23,28,29 . Out of 330 patients, 178 (53.9%) patients were receiving some sort of treatment for their IBD: 33 (13.6%) of 242 patients (six studies) received steroids, 17,18,21‐23,29 126 (40.6%) of 310 patients (eight studies) received immunomodulators/anti‐inflammatory 17,18,20‐23,28,29 and 41 (13.1%) of 314 patients (eight studies) received biologics at the time of surgery 17,18,20‐23,25,29 …”

“…Ten studies reported data on the type of bariatric surgery in patients with IBD 11,17,18,20‐25,28 . Of 727 total patients, 342 (47.0%) patients underwent SG, 120 (16.5%) underwent GB, 256 (35.2%) patients underwent RYGB and 9 (1.2%) patients underwent other surgeries.…”

Bariatric Surgery and Inflammatory Bowel Disease: a Role for Microbiota?

“…Currently, bariatric surgery is the more appropriate therapeutic option for obese patients who failed an adequate exercise and diet program, and who present with obesity-related comorbid conditions. Few data about the efficacy and safety of bariatric surgery in patients affected by IBD are available in literature, probably due to the fear to perform abdominal surgery in these patients [6,7]. bariatric surgery seemed to be not only effective (weight lost at one and two years after surgery was of about 70% and 60%, respectively, comparable to the literature data [9]), but also safe (they did not observe any major surgical complication and no IBD patients relapsed).…”