Past History of Bariatric Surgery Associated with Increased Risk of new Onset Inflammatory Bowel Disease

Abstract Background & Aims The aim of this study was to examine the risk of new-onset inflammatory bowel disease (IBD) following bariatric surgery. Methods We conducted a nationwide population-based prospective cohort study of the entire Danish population 18 to 60 years of age alive and residing in Denmark from 1996 to 2018. Bariatric surgery was included as a time-dependent variable, and Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of IBD. We used a model adjusting for age, sex, and birth cohort and a multifactor-adjusted model additionally including educational status and number of obesity-related comorbidities. Results We followed 3,917,843 individuals, of which 15,347 had a bariatric surgery, for development of new-onset IBD. During 106,420 person-years following bariatric surgery, 100 IBD events occurred (incidence rate 0.940 / 1000 person years). During 55,553,785 person-years without bariatric surgery, 35,294 events of IBD occurred (incidence rate 0.635 / 1000 person-years). This corresponded to a multifactor-adjusted HR of 1.15 (95% CI, 0.94-1.40) for IBD. Multifactor-adjusted HRs of Crohn’s disease (CD) and ulcerative colitis (UC) were 1.85 (95% CI, 1.40-2.44) and 0.81 (95% CI, 0.61-1.08), respectively. Among women, the multifactor-adjusted HR for CD was 2.18 (95% CI, 1.64-2.90). When limiting the study population to individuals with a diagnosis of overweight/obesity, bariatric surgery remained associated with increased risk of CD, multifactor-adjusted HR 1.59 (95% CI, 1.18-2.13). Conclusions This nationwide cohort study shows that bariatric surgery is associated with increased risk of development of new-onset CD, but not of UC. The underlying mechanisms remain elusive.

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Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study

Gut ◽

10.1136/gutjnl-2018-317610 ◽

2019 ◽

Vol 68 (9) ◽

pp. 1597-1605 ◽

Cited By ~ 5

Author(s):

Simone N Vigod ◽

Paul Kurdyak ◽

Hilary K Brown ◽

Geoffrey C Nguyen ◽

Laura E Targownik ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Mental Illness ◽

Cohort Study ◽

Bowel Disease ◽

Post Partum ◽

Population Based ◽

Incidence Rates ◽

Increased Risk ◽

Inflammatory Bowel ◽

New Onset

ObjectivePatients with inflammatory bowel disease (IBD) have an elevated risk of mental illness. We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and post partum.DesignThis cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.ResultsAbout 22.7% of women with IBD had new-onset mental illness versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care and infant mortality.ConclusionWomen with IBD were at an increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.

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Asymptomatic Crohn’s disease identified in a patient being treated with secukinumab: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x19893580 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1989358

Author(s):

Wasim Haidari ◽

Sarah Al-Naqshabandi ◽

Christine S Ahn ◽

Richard S Bloomfeld ◽

Steven R Feldman

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Gastrointestinal Symptoms ◽

Good Choice ◽

History Of ◽

Inflammatory Bowel ◽

Multiple Ulcers ◽

New Onset

IL-17 antagonism is among the most potent treatments for psoriasis. Generally safe, new onset and exacerbations of inflammatory bowel disease may occur in association with IL-17 therapy. We describe a patient with long-standing history of psoriasis and psoriatic arthritis in whom asymptomatic Crohn’s disease was identified during treatment with secukinumab. The patient underwent an elective colonoscopy for colorectal cancer screening which revealed inflammation and multiple ulcers in the terminal ileum suggestive of Crohn’s disease. While the patient did not have any gastrointestinal symptoms, he was diagnosed as having asymptomatic Crohn’s disease. Given the association of inflammatory bowel disease with secukinumab treatment, secukinumab was discontinued. Although in this patient, Crohn’s disease was identified during treatment with secukinumab, a direct causal relationship cannot be assumed. Medications that are effective for both psoriasis and inflammatory bowel disease may be a good choice in patients with psoriasis who have comorbid Crohn’s disease or develop inflammatory bowel disease during treatment with another biologic.

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P746 Prevalence, features and outcomes of splachnic vein thrombosis in inflammatory bowel disease. A nationwide, retrospective study from the ENEIDA registry

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.874 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S598-S598

Author(s):

H Masnou ◽

M Mañosa ◽

L Menchén ◽

F Mesonero ◽

L Bujanda ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Past History ◽

Anticoagulation Therapy ◽

Oesophageal Varices ◽

Vein Thrombosis ◽

Inflammatory Conditions ◽

History Of ◽

Inflammatory Bowel

Abstract Background The risk of splanic vein thrombosis (SVT) -as defined as that involving the portal vein and/or its intrahepatic branches, mesenteric, splenic and/or suprahepatic veïns is mainly observed, among others, in inflammatory abdominal conditions. Thromboembolic complications are frequent among patients with inflammatory bowel disease (IBD). However, there is little information on the prevalence, characteristics, risk factors and evolution of SVT in patients with IBD. Our aims were to describe the characteristics of SVT in patients with IBD, diagnostic explorations, treatment and evolution. Methods Retrospective, multicentre, descriptive study of the ENEIDA registry with a diagnosis of SVT. In addition to epidemiological and clinical features of IBD, we recorded specifically diagnosis, treatment, disease activity at the time of SVT and outcome of SVT. Results Over 59,000 IBD patients in the ENEIDA registry, only 49 episodes of SVT were identified (35 Crohn’s / 14 Ulcerative Colitis); 69% men, median age 42 years old, 35% smokers. 37% had a past history of surgery and/or abdominal inflammatory conditions, 16% extra-intestinal neoplasia, 23% baseline immune or hematologic conditions and 14% liver disease. Finally, 16% had a previous episode of venous thrombosis. The most frequent forms of clinical presentation were abdominal pain with/without fever (59%), and radiological findings in the setting of active IBD (25%). ST coincided with IBD activity in 76% of cases. The diagnosis of SVT was based in the findings of an abdominal CT in 82%. The most frequent localition of SVT were intrahepatic portal branches (51%) and superior mesenteric vein (47%). Only 47% had a basic aetiological study, and 37% underwent gastroscopy (median 7 months from the diagnosis of SVT) showing oesophageal varices in 67%. Anticoagulation therapy was prescribed in 94% of the episodes (74% within the first month since diagnosis), for a median of 7 months. In 90% of the cases, there was a further radiological assessment, 61% of which showing the resolution of the SVT (median of 5 months from the beginning anticoagulation treatment). Conclusion SVT seems to be a rare (or underdiagnosed) complication in IBD patients, it is mostly associated with disease activity and evolves suitably when anticoagulation therapy is suitably started.

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Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Case-Control Study from the GETAID

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab249 ◽

2021 ◽

Author(s):

Catherine Reenaers ◽

Arnaud de Roover ◽

Laurent Kohnen ◽

Maria Nachury ◽

Marion Simon ◽

...

Keyword(s):

Bariatric Surgery ◽

Inflammatory Bowel Disease ◽

Weight Loss ◽

Bowel Disease ◽

Small Sample ◽

Control Group ◽

Prevalence Of Obesity ◽

History Of ◽

Inflammatory Bowel ◽

Small Sample Sizes

Abstract Background The prevalence of obesity and the number of bariatric surgeries in both the general population and in patients with inflammatory bowel disease (IBD) have increased significantly in recent years. Due to small sample sizes and the lack of adequate controls, no definite conclusions can be drawn from the available studies on the safety and efficacy of bariatric surgery (BS) in patients with IBD. Our aim was to assess safety, weight loss, and deficiencies in patients with IBD and obesity who underwent BS and compare findings to a control group. Methods Patients with IBD and a history of BS were retrospectively recruited to centers belonging to the Groupe d’Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID). Patients were matched 1:2 for age, sex, body mass index (BMI), hospital of surgery, and type of BS with non-IBD patients who underwent BS. Complications, rehospitalizations, weight, and deficiencies after BS were collected in cases and controls. Results We included 88 procedures in 85 patients (64 Crohn’s disease, 20 ulcerative colitis, 1 unclassified IBD) with a mean BMI of 41.6 ± 5.9 kg/m2. Bariatric surgery included Roux-en-Y gastric bypass (n = 3), sleeve gastrectomy (n = 73), and gastric banding (n = 12). Eight (9%) complications were reported, including 4 (5%) requiring surgery. At a mean follow-up of 34 months, mean weight was 88.6 ± 22.4 kg. No difference was observed between cases and controls for postoperative complications (P = .31), proportion of weight loss (P = .27), or postoperative deficiencies (P = .99). Conclusions Bariatric surgery is a safe and effective procedure in patients with IBD and obesity; outcomes in this patient group were similar to those observed in a control population.

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753 A History of Colorectal Neoplasia Is Associated With an Increased Risk of Ileo-Anal Pouch Neoplasia in a Nationwide Inflammatory Bowel Disease Cohort

Gastroenterology ◽

10.1016/s0016-5085(13)60493-x ◽

2013 ◽

Vol 144 (5) ◽

pp. S-136-S-137

Author(s):

Lauranne A. Derikx ◽

Wietske Kievit ◽

Dirk J. De Jong ◽

Cyriel Ponsioen ◽

Bas Oldenburg ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Colorectal Neoplasia ◽

Increased Risk ◽

History Of ◽

Inflammatory Bowel

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Impact of Bariatric Surgery on the Natural History of Inflammatory Bowel Disease

Gastroenterology ◽

10.1016/s0016-5085(17)31478-6 ◽

2017 ◽

Vol 152 (5) ◽

pp. S367

Author(s):

Manuel Bonfim Braga Neto ◽

Guilherme Piovezani Ramos ◽

Edward V. Loftus ◽

David H. Bruining ◽

Fateh Bazerbachi ◽

...

Keyword(s):

Bariatric Surgery ◽

Inflammatory Bowel Disease ◽

Natural History ◽

Bowel Disease ◽

History Of ◽

Inflammatory Bowel

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P729 The SAPPHIRE registry: Safety of immunosuppression in a prospective cohort of inflammatory bowel disease patients with a HIstoRy of CancEr

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.857 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S585-S587

Author(s):

J Axelrad ◽

J F Colombel ◽

E Scherl ◽

D Lukin ◽

S Chang ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

New York ◽

Bowel Disease ◽

Small Sample ◽

Recurrent Cancer ◽

Increased Risk ◽

History Of ◽

Diagnosis Of Cancer ◽

Inflammatory Bowel ◽

History Of Cancer

Abstract Background Previous retrospective studies have demonstrated that patients with inflammatory bowel disease (IBD) exposed to anti-TNF and/or immunomodulators (IMM) following a diagnosis of cancer were not at an increased risk of new or recurrent cancer compared with those unexposed to these agents. Prospective studies are lacking and little is known about cancer risk with ustekinumab and vedolizumab. The SAPPHIRE Registry was developed to prospectively examine whether patients with IBD and a history of cancer subsequently exposed to immunosuppressive IBD therapies are at greater risk of new or recurrent cancer compared with those not exposed to immunosuppression. Methods We are longitudinally following patients with IBD and a histologically confirmed first cancer within the last five years from 8 centres affiliated with the New York Crohn’s and Colitis Organization (NYCCO) between 2017 and 2019. Patients receiving chemotherapy or radiation at enrolment, a first cancer more than 5 years prior to study entry, or recurrent cancer within the last 5 years are excluded. Cancers are categorised into luminal gastrointestinal (GI), hematologic, dermatologic, and other solid malignancies. Our primary outcome is the development of new or recurrent cancer stratified by immunosuppression exposure. Results We identified 170 patients with IBD and a history of a first cancer within the last 5 years (Table 1). The average age at IBD diagnosis was 36 years; average age at cancer diagnosis was 54 years. Patients were 49% male, 91% white, and 39% former smokers. Prior cancers were solid (78; 46%), GI (23; 14%), dermatologic (59; 35%), and hematologic (12; 7%) malignancies. Following a diagnosis of cancer, patients were exposed to IMM (38; 22%), anti-TNF (45; 26%), vedolizumab (41; 23%), ustekinumab (17; 10%), or no immunosuppression (33; 19%; Table 2). During follow-up, 13 (8%) patients developed 14 subsequent cancers (6 new, 8 recurrent) comprising 6 (43%) solid, 1 (7%) gastrointestinal, and 7 (50%) dermatologic malignancies. Compared to patients not exposed to immunosuppression, exposure to an IMM (RR 4.94, 95% CI 0.50, 48.6) or a biologic (RR 3.53, 95% CI 0.71, 17.5) was not associated with an increased risk of new or recurrent cancer. However, exposure to combination therapy with an IMM and a biologic (RR 6.81, 95% CI 1.40, 33.2) was associated with an increased risk in this small sample. Conclusion In this ongoing prospective study, exposure to immunosuppressive IBD monotherapies in patients with IBD and a recent history of cancer has so far conferred no increased risk of new or recurrent cancer. Continued enrolment will enable a more refined estimate of the safety of combination therapies.

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