Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease

Aminian, Ali; Andalib, Amin; Ver, Maria R.; Corcelles, Ricard; Schauer, Philip R.; Brethauer, Stacy A.

doi:10.1007/s11695-015-1909-y

Cited by 68 publications

(52 citation statements)

References 26 publications

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“…Although bariatric surgery is technically feasible in patients with IBD, long-term consequences of major restrictive and malabsorptive procedures in these individuals are poorly understood. Case series have suggested that these procedures are safe in highly selected patients who are morbidly obese and have IBD, and have also anecdotally observed improvement in disease activity after weight loss 115,116 . However, short of bariatric surgery, other weight loss interventions would also probably be beneficial.…”

Section: Obesity Treatment and Ibd Outcomesmentioning

confidence: 99%

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Singh

Dulai

Zarrinpar

et al. 2016

Nat Rev Gastroenterol Hepatol

318

285

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Incidence of IBD is rising in parallel with overweight and obesity. Contrary to conventional belief, about 15–40% of patients with IBD are obese, which might contribute to the development of IBD. Findings from cross-sectional and retrospective cohort studies are conflicting on the effect of obesity on natural history and course of IBD. Most studies are limited by small sample size, low event rates, non-validated assessment of disease activity and lack robust longitudinal follow-up and have incomplete adjustment for confounding factors. The effect of obesity on the efficacy of IBD-related therapy remains to be studied, though data from other autoimmune diseases suggests that obesity results in suboptimal response to therapy, potentially by promoting rapid clearance of biologic agents leading to low trough concentrations. These data provide a rationale for using weight loss interventions as adjunctive therapy in patients with IBD who are obese. Obesity also makes colorectal surgery technically challenging and might increase the risk of perioperative complications. In this Review, we highlight the existing literature on the epidemiology of obesity in IBD, discuss its plausible role in disease pathogenesis and effect on disease course and treatment response, and identify high-priority areas of future research.

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Section: Obesity Treatment and Ibd Outcomesmentioning

confidence: 99%

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Singh

Dulai

Zarrinpar

et al. 2016

Nat Rev Gastroenterol Hepatol

318

285

View full text Add to dashboard Cite

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“…Nijhuis et al [36] found a significant decrease in serum calprotectin levels (in 11 out of 15 patients) from a mean of 119.6 ± 31.5 ng/ml to a mean of 93.9 ± 42.7 ng/ml (p < 0.001) 2 years postoperatively, suggesting a state of lower neutrophil activation following BS-induced weight loss. Theoretically, the decreased inflammatory state following BS might favorably impact the evolution of IBD; however, surgically induced malabsorption and abdominal surgery including intestinal manipulation might also adversely impact IBD patients [37,38,39]. The eventual complications that may be more frequent in IBD include anastomotic leak, fistula, abscess, bowel stricture, and bowel obstruction [40].…”

Section: Outcomes Of Bs In Ibd Patientsmentioning

confidence: 99%

“…They concluded that BS in IBD patients offers a double benefit: on top of reducing systemic inflammation, the decrease in BMI reduces the pharmacological volume of distribution to the normal therapeutic range of immunosuppressive therapy. Aminian et al [39] retrospectively identified 13 UC and 7 CD patients who underwent RYGBP, SG, or gastric banding in a large-volume bariatric center. Several early complications were reported, i.e.…”

Section: Outcomes Of Bs In Ibd Patientsmentioning

confidence: 99%

“…However, the selection of the optimal bariatric procedure for a morbidly obese patient involves many considerations. As the IBD population is at risk for intestinal malabsorption, enteric fistulas, and bacterial overgrowth, most authors and 87% of the experts from the Fifth International Consensus Conference on current status of SG recommend the use of SG [37,38,39,41,56]. SG achieves satisfying metabolic results and involves the operation of the stomach only, which is in most of the cases free from IBD [37].…”

Section: Recommendations On Bs In Ibdmentioning

confidence: 99%

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Does Gastric Surgery (Such as Bariatric Surgery) Impact the Risk of Intestinal Inflammation?

2016

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Background: The prevalence of morbid obesity and inflammatory bowel disease (IBD) is on the rise in association with a Western lifestyle. Both conditions are characterized by chronic inflammation. Bariatric surgery (BS) is a recommended and widely used approach to address severe obesity and its related comorbidities. Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) are the most frequently performed procedures worldwide. Evidence is scarce on outcomes of BS in IBD patients. Summary: Systemic and adipose-tissue inflammation seems to decrease following BS. Different studies observed decreased serum levels of inflammatory markers (CRP, IL-6, MCP-1, and TNF-α) along with a reduction of insulin resistance both after RYGBP and SG. Several authors documented postbariatric improvement of concomitant chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus, gout, and psoriasis). There are only few retrospective case series on outcomes of BS in IBD patients. These studies reported safety and feasibility of BS and improvement in IBD status, manifested by prolonged disease remission and decreased use of pharmacotherapy. Weight loss outcomes were excellent and similar to those of non-IBD patients. The preferred surgical approach for morbidly obese IBD patients is SG in order to avoid potential drawbacks of RYGBP, such as malabsorption, intestinal manipulation, and augmentation of technical difficulties for future IBD surgery. Seven cases of newly diagnosed IBD after BS have been reported, which are more likely to result from postoperative intestinal microbial dysbiosis than from directly induced inflammation. Key Messages: This review summarizes the outcomes of BS in IBD patients. SG is the preferable technique for morbidly obese IBD patients, who have potentially a double benefit from BS: weight loss and IBD remission. Further research is necessary to clarify the common pathophysiology of chronic inflammation in morbid obesity and in IBD. Postbariatric changes in gut microbiota should also be assessed to understand whether they promote IBD development or not.

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“…These studies have suggested that bariatric surgery is safe, efficacious, and may even have disease-modifying effects such as reduction in symptoms, clinical/endoscopic remission, and reduction in need for therapeutic immunomodulatory agents [9-12]. The objectives of this study were to examine safety and efficacy of bariatric surgery in patients with IBD, as well as to explore any impact on IBD disease course after bariatric surgery.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Outcomes of Bariatric Surgery in Patients with Inflammatory Bowel Disease

Abstract: Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.

Cited by 68 publications

References 26 publications

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Does Gastric Surgery (Such as Bariatric Surgery) Impact the Risk of Intestinal Inflammation?

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

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