Obese patients with inflammatory bowel disease (IBD) had weight loss and resolution of other obesity-related complications, similar to that of patients without IBD, after bariatric surgery, a small retrospective study showed.
Weight loss varied substantially by the type of bariatric procedure used, ranging from 26 percent of excess weight with adjustable banding to 95 percent with sleeve gastrectomy. The 17 patients in the study had a variety of obesity-related health problems, all 17 had resolution or improvement in the conditions, including diabetes, hypertension, sleep apnea, hyperlipidemia, and gastroesophageal reflux disease (GERD).
“These patients have done really well,” David Gagné, MD, of West Penn Allegheny Health System in Pittsburgh, told MedPage Today. “With the exception of three Crohn’s patients who had postoperative complications, the patients have had no problems.”
Follow-up is pretty much the same as with other patients without IBD. They are on the same nutrition regimen. We follow them regularly and check their lab results, which are usually normal,” he explained.
Crohn’s disease and ulcerative colitis has been considered a relative contraindication to bariatric surgery. Published case reports have offered conflicting information about the effect of bariatric surgery on these IBDs. Some have suggested the surgery exacerbates IBD symptoms, and others have provided evidence that surgery-induced weight loss reduces systemic inflammation, leading to better symptom control and reduced medication use.
To add to the knowledge base, Gagne and colleagues retrospectively reviewed outcomes of 3,002 patients who underwent bariatric surgery from July 1999 to May 2012. The records included 13 of 17 patients who had a history of IBD: eight with ulcerative colitis and nine with Crohn’s disease.
The patients with IBD had a median age of 54, median BMI of 46.7, and 13 were women. Five of the patients had a history of surgical treatment for IBD, consisting of total colectomy with ileostomy in three patients, abdominal perineal resection in one patient, and total colectomy and small-bowel resection in one patient.
Gagné reported that 11 patients underwent laparoscopic Roux-en-Y gastric bypass, four had laparoscopic adjustable banding, and one patient had sleeve gastrectomy. Surgery was aborted in one patient with Crohn’s disease found to have small-bowel anastomoses and small-bowel bypass.
The patients had a median follow-up of 34 months and a range of 9 to 110 months. Excess weight lost averaged 67 percent in gastric bypass patients, 26 percent in the gastric-band patients, and 95 percent in the one patient who underwent sleeve gastrectomy.
Data on improvement in obesity-related health problems showed that resolution occurred in:
- Five of seven patients with type 2 diabetes
- Five of nine patients with hypertension
- All four patients with sleep apnea
- Three of four patients with hyperlipidemia
- All four patients with GERD
The remaining patients had improvement in their obesity-related health problems. One patient with preoperative GERD had new onset of symptoms after gastric banding.
Three patients — all with a history of Crohn’s disease — had postoperative complications, consisting of one case each of lower gastrointestinal bleeding of unknown origin, abdominal phlegmon, and abscess with stomal hernia necessitating port removal.
Gagné said one additional patient had developed Crohn’s disease 9 months after gastric bypass surgery.
The authors concluded that IBD can complicate bariatric surgery, but should not be a contraindication to bariatric surgery