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Bariatric surgery found to be effective in IBD patients


 

REPORTING FROM DDW 2019

– In carefully selected patients with well-controlled inflammatory bowel disease (IBD), bariatric surgery results in sustained weight loss over a 2-year period, results from a retrospective study suggest.

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“Obesity is increasing in patients with inflammatory bowel disease at a rate similar to that seen in the general population,” the study’s primary author, Nicholas P. McKenna, MD, said in an interview in advance of the annual Digestive Disease Week. “While bariatric surgery is a well-accepted therapy for obesity in patients without IBD, its use in patients with IBD is less well studied.”

For the current study, Dr. McKenna, a resident in the department of surgery at the Mayo Clinic in Rochester, Minn., and colleagues collected data on 33 patients who underwent bariatric surgery with a pre- or postoperative diagnosis of IBD across three academic centers between August 2006 and December 2017. They evaluated IBD characteristics and medications; postoperative complications; the need for future IBD-related surgery; and weight loss at 6, 12, and 24 months.

Dr. Nicholas P. McKenna


The patients underwent 34 bariatric operations. Their median age was 51 years and their median duration of IBD was 13 years. Of the 33 patients, 16 underwent a Roux-en-Y gastric bypass procedure: 9 who had ulcerative colitis, 6 who had Crohn’s disease, and 1 who had indeterminate colitis. A total of 14 patients underwent sleeve gastrectomy: 7 who had ulcerative colitis and 7 who had Crohn’s disease. Four patients underwent a gastric band procedure, all of whom had ulcerative colitis. The mean body mass index of patients prior to their bariatric procedures was 42.7 kg/m2. A total of 31 patients had an existing diagnosis of IBD, and 2 were diagnosed with Crohn’s disease after Roux-en-Y gastric bypass. In addition, 9 patients were on preoperative immunosuppression for IBD, and 11 had undergone prior intestinal resection for IBD.

Dr. McKenna reported that the average hospitalization for all patients was 3.6 days and that only four 30-day infectious complications occurred: two superficial surgical site infections, one infected intra-abdominal hematoma, and one hepatic abscess. In the long term, seven patients required reoperation: three for failed gastric band, two for reduction of internal hernia, and two for cholelithiasis. The researchers found that the mean percentage of overall excess weight loss was 57.5% at 6 months, 63.3% at 12 months, and 58.6% at 24 months. During a mean follow-up of 3.4 years, no IBD flares requiring surgery were observed.

“Our hypothesis based on the existing literature was that bariatric surgery would be safe in carefully selected patients with IBD and result in sustained weight loss, so we were not surprised with these results,” Dr. McKenna said. “We were not sure if medication requirements would change after surgery as the literature is conflicted on this. We observed that most patients continued to require no immunosuppression for control of their IBD after surgery. Further, we did not observe that any patients required future surgery at the time of last follow-up for an IBD flare.”

He acknowledged certain limitations of the study, including its retrospective design. “Additionally, though it is a relatively large sample, compared to the existing literature on bariatric surgery in IBD, it is still only 33 patients. This limits the comparisons that can be performed between patients with ulcerative colitis and Crohn’s disease and between the operation choices.”

The study’s secondary author, Alaa Sada, MD, a surgery resident at Mayo, presented the findings at the meeting. The researchers reported having no financial disclosures.

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