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Bariatric surgery in severely obese patients with inflammatory bowel disease: a systematic review
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Surgery for Obesity and Related Diseases ] (2017) 00–00
Editorial
Bariatric surgery in severely obese patients with inflammatory bowel disease: a systematic review This article presents a meta-analysis of patients with inflammatory bowel disease (IBD) who underwent weight loss surgery. They found reliable information on 43 patients, 25 with Crohn’s disease (CD) and 18 with ulcerative colitis (UC). Of these, 63% were treated with sleeve gastrectomy (SG), 23% with Roux-en-Y gastric bypass (RYGB), and 14% with adjustable gastric band (AGB). A total of 92% of the patients with CD had either SG or AGB, and 2 patients (8%) had RYGB. Of the patients with UC, 44% were treated with RYGB and 44% with SG, with 12% having AGB. The patients had an acute operative morbidity of 21% and late postoperative morbidity of 24%, with none of the morbidity being related to IBD. With a follow up of 8–77 months, weight loss averaged 71% of excess weight. Neither a good nor bad effect of the bariatric procedure on IBD could be determined from this paper. What can we glean from this article? It is reasonable to cautiously proceed with bariatric procedures in severely obese patients with diagnosed IBD, provided their disease is stable or quiescent. It would seem prudent to apply gastric procedures (i.e., SG) in most patients, particularly those with CD because CD may involve various segments of the small bowel in the future. There is some data which suggest that late onset CD is a more severe disease in the severely obese hypothetically from the chronic inflammatory state seen in those patients. These data are at present rudimentary, but they nevertheless support the possibility that weight reduction would produce some amelioration of the severity of CD [1]. No relationship between UC and obesity had been established. Surgical procedures often performed in IBD patients such as total colectomy with ileoanal pull-through in patients with UC and ostomies in patients with UC and CD are technically more difficult in severely obese patients. Occasionally, it is not possible to perform the ileoanal pull-through after colectomy in severely obese patients with
UC. Thus, weight loss surgery in these patients would confer an advantage if they required surgical treatment for IBD [2]. As a consequence of disease, most patients with UC and CD are underweight, so bariatric surgeons will not see many of these patients [3]. However, in recent years, the incidence of obesity in CD and UC has increased. In a study from Scotland published in 2009, 18% of the population with IBD was obese (body mass index 430 kg/m2), compared with 23% in the general population [4]. If this trend holds in other populations, bariatric surgeons will be called upon to treat more patients with IBD. It would be judicious to set up a protocol for follow-up of these patients to further determine outcomes and ascertain if there is any effect of these bariatric procedures on UC or CD. Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article. Clifford W Deveney, M.D Oregon Health Sciences University, Department of Surgery Portland, Oregon References [1] Mendall MA, Gunasekera AV, John BJ, Kumar D. Is obesity a risk factor for Crohn’s Disease? Dig Dis Sci 2011;56(3):837–44. [2] Boutros M, Maron D. Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg 2011;24(4):244–52. [3] Blain A, Cattan S, Beaugerie L, Carbonnel F, Gendre JP, Cosnes J. Crohn’s disease clinical course and severity in obese patients. Clin Nutr 2002;21(1):51–7. [4] Steed H, Walsh S, Reynolds N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts 2009;2(6):370–2.
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Surgery for Obesity and Related Diseases ] (2017) 00–00
Editorial
Bariatric surgery in severely obese patients with inflammatory bowel disease: a systematic review This article presents a meta-analysis of patients with inflammatory bowel disease (IBD) who underwent weight loss surgery. They found reliable information on 43 patients, 25 with Crohn’s disease (CD) and 18 with ulcerative colitis (UC). Of these, 63% were treated with sleeve gastrectomy (SG), 23% with Roux-en-Y gastric bypass (RYGB), and 14% with adjustable gastric band (AGB). A total of 92% of the patients with CD had either SG or AGB, and 2 patients (8%) had RYGB. Of the patients with UC, 44% were treated with RYGB and 44% with SG, with 12% having AGB. The patients had an acute operative morbidity of 21% and late postoperative morbidity of 24%, with none of the morbidity being related to IBD. With a follow up of 8–77 months, weight loss averaged 71% of excess weight. Neither a good nor bad effect of the bariatric procedure on IBD could be determined from this paper. What can we glean from this article? It is reasonable to cautiously proceed with bariatric procedures in severely obese patients with diagnosed IBD, provided their disease is stable or quiescent. It would seem prudent to apply gastric procedures (i.e., SG) in most patients, particularly those with CD because CD may involve various segments of the small bowel in the future. There is some data which suggest that late onset CD is a more severe disease in the severely obese hypothetically from the chronic inflammatory state seen in those patients. These data are at present rudimentary, but they nevertheless support the possibility that weight reduction would produce some amelioration of the severity of CD [1]. No relationship between UC and obesity had been established. Surgical procedures often performed in IBD patients such as total colectomy with ileoanal pull-through in patients with UC and ostomies in patients with UC and CD are technically more difficult in severely obese patients. Occasionally, it is not possible to perform the ileoanal pull-through after colectomy in severely obese patients with
UC. Thus, weight loss surgery in these patients would confer an advantage if they required surgical treatment for IBD [2]. As a consequence of disease, most patients with UC and CD are underweight, so bariatric surgeons will not see many of these patients [3]. However, in recent years, the incidence of obesity in CD and UC has increased. In a study from Scotland published in 2009, 18% of the population with IBD was obese (body mass index 430 kg/m2), compared with 23% in the general population [4]. If this trend holds in other populations, bariatric surgeons will be called upon to treat more patients with IBD. It would be judicious to set up a protocol for follow-up of these patients to further determine outcomes and ascertain if there is any effect of these bariatric procedures on UC or CD. Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article. Clifford W Deveney, M.D Oregon Health Sciences University, Department of Surgery Portland, Oregon References [1] Mendall MA, Gunasekera AV, John BJ, Kumar D. Is obesity a risk factor for Crohn’s Disease? Dig Dis Sci 2011;56(3):837–44. [2] Boutros M, Maron D. Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg 2011;24(4):244–52. [3] Blain A, Cattan S, Beaugerie L, Carbonnel F, Gendre JP, Cosnes J. Crohn’s disease clinical course and severity in obese patients. Clin Nutr 2002;21(1):51–7. [4] Steed H, Walsh S, Reynolds N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts 2009;2(6):370–2.
49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 Q1 83 84 85 86 87 88 89 90 91 92 93 94 95 96