Amandeep Singh, MD
Cleveland Clinic Foundation
Cleveland, Ohio
Amandeep Singh, MD, Ali Aminian, MD, Lan Nan, MD, Bo Shen, MD, FACG, Philip Schauer, MD, Miguel Regueiro, MD, FACG
Cleveland Clinic Foundation, Cleveland, OH
Introduction: Approximately 32–52% of inflammatory bowel disease (Crohn’s disease [CD] and ulcerative colitis [UC]) patients have obesity or are overweight. Bariatric surgery (BS) is a recommended and widely used approach to address severe obesity and its related comorbidities. However, data on the effect of BS on IBD are equivocal. We aimed to assess the course of IBD after BS.
Methods: Using ICD-9 codes all IBD patients who underwent BS (Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG] or gastric band/balloon [GB]) at a major referral center between January 2000-June 2018 were identified. Data on baseline demographics, co-morbidities and concomitant medications was collected. Laboratory data, endoscopic data (Mayo score for UC and Simple Endoscopy score [SES] for CD), patient reported outcomes (PROs) and medications at baseline and 6-12 months after BS were collected. We also assessed exacerbation of IBD, hospitalization and adverse events after BS.
Results: A total of 58 IBD patients (46.6% CD and 53.4% UC) underwent BS (79.3% GS, 15.5% RYGB and 5.2% GB) during the study period. Our cohort consisted of 74% females and 81% were Caucasians. At the time of BS, mean age was 47.8±12.2 years, mean BMI was 43.5±7, and 36.2% were active smokers. Compared to baseline, 6 months after BS, a decrease in WBC (8.6±3 vs. 7.2±2), CRP (0.7 vs. 0.6), aspartate aminotransferase (34.1±28 vs. 23.5±10) and alanine aminotransferase (34.4±28 vs. 20.2±11) and an increase in vitamin D (25.5±15 vs. 20.2±11) (p< 0.05 for all) was noted. Beside the significant decrease in BMI (43.5±7 vs. 36.3±7) and HbA1C (5.6 vs. 5.2), extraintestinal manifestation of IBD also improved (50% vs. 5.2%) (p< 0.05 for all). There was no differences in PROs, IBD therapy, and endoscopy scores (Table 1). Five patients (8.6%) had IBD exacerbation (all after GS) of which two had active disease at the time of BS, only two required hospitalization and intravenous steroids, but none of the patients required any further surgery or intervention.
Discussion: To date, our study is the largest on the natural course of IBD after bariatric surgery. A significant improvement in BMI, HbA1c, liver enzymes and IBD-related extraintestinal manifestations were noted after bariatric procedures. Longer follow-up is required, but based on these results; bariatric surgery for obesity appears to be safe in IBD patients.
Citation: Amandeep Singh, MD, Ali Aminian, MD, Lan Nan, MD, Bo Shen, MD, FACG, Philip Schauer, MD, Miguel Regueiro, MD, FACG. P1418 - THE NATURAL COURSE OF INFLAMMATORY BOWEL DISEASE AFTER BARIATRIC SURGERY. Program No. P1418. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.