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

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.

Risk of de-novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

2020 ◽  
Vol 51 (11) ◽  
pp. 1067-1075 ◽  
Author(s):  
Gursimran S. Kochhar ◽  
Aakash Desai ◽  
Aslam Syed ◽  
Abhinav Grover ◽  
Sandra El Hachem ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Bowel Disease ◽  
De Novo ◽  
Obese Patients ◽  
Inflammatory Bowel ◽  
Weight Loss Medications

scholarly journals Efficacy of Dietary Supplements in Inflammatory Bowel Disease and Related Autoimmune Diseases

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2156 ◽  
Author(s):  
Priyanka Jadhav ◽  
Yan Jiang ◽  
Karolin Jarr ◽  
Cosima Layton ◽  
Judith F. Ashouri ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Immune Response ◽  
Psoriatic Arthritis ◽  
Bowel Disease ◽  
Inflammatory Diseases ◽  
Small Sample ◽  
Therapeutic Options ◽  
Current Evidence ◽  
Inflammatory Bowel ◽  
Small Sample Sizes

The microbiome is an important contributor to a variety of fundamental aspects of human health, including host metabolism, infection, and the immune response. Gut dysbiosis has been identified as a contributor to the errant immune response in a variety of immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriatic disease (psoriasis and psoriatic arthritis). Given this, probiotics and prebiotics have been investigated as therapeutic options in these disease states. In our review, we highlight the current evidence on prebiotics and probiotics as well as other supplements (such as fish oils, vitamin D, and curcumin) as therapies for IBD. Recommendations, however, regarding the specific use of such supplements in IBD have been lacking, particularly from professional societies, often due to study limitations related to small sample sizes and design heterogeneity. Hence, we additionally examine the literature on the use of prebiotics, probiotics, and other supplements in related IMIDs, namely RA and psoriasis/psoriatic arthritis, as these diseases share many approved therapeutic options with IBD. Based on these combined findings, we offer additional evidence that may help guide clinicians in their treatment of patients with IBD (and other IMIDs) and provide recommendations on potential next steps in therapeutic research in this area.

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

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

scholarly journals P733 Past history of bariatric surgery associated with increased risk of new onset inflammatory bowel disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S455-S456 ◽  
Author(s):  
R. Ungaro ◽  
H. Chang ◽  
L. Roque Ramos ◽  
R. Fausel ◽  
J. Torres ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Past History ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
New Onset

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

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.

scholarly journals Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease

2019 ◽  
Vol 26 (7) ◽  
pp. 1089-1097 ◽  
Author(s):  
Manuel B Braga Neto ◽  
Martin H Gregory ◽  
Guilherme P Ramos ◽  
Fateh Bazerbachi ◽  
David H Bruining ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Bowel Disease ◽  
Inflammatory Bowel ◽  
A Prospective Study ◽  
Prospective Study Design ◽  
The Impact

Abstract Background An association between inflammatory bowel disease (IBD) and obesity has been observed. Little is known about the effect of weight loss on IBD course. Our aim was to determine the impact of bariatric surgery on long-term clinical course of obese patients with IBD, either Crohn's disease (CD) or ulcerative colitis (UC). Methods Patients with IBD who underwent bariatric surgery subsequent to IBD diagnosis were identified from 2 tertiary IBD centers. Complications after bariatric surgery were recorded. Patients were matched 1:1 for age, sex, IBD subtype, phenotype, and location to patients with IBD who did not undergo bariatric surgery. Controls started follow-up at a time point in their disease similar to the disease duration in the matched case at the time of bariatric surgery. Inflammatory bowel disease medication usage and disease-related complications (need for corticosteroids, hospitalizations, and surgeries) among cases and controls were compared. Results Forty-seven patients met inclusion criteria. Appropriate matches were found for 25 cases. Median follow-up among cases (after bariatric surgery) and controls was 7.69 and 7.89 years, respectively. Median decrease in body mass index after bariatric surgery was 12.2. Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.08–1.23; 12% vs 28%; OR, 0.2; 95% CI, 0.004–1.79). Two cases and 1 control were able to discontinue biologics during follow-up. Conclusions Inflammatory bowel disease patients with weight loss after bariatric surgery had fewer IBD-related complications compared with matched controls. This observation requires validation in a prospective study design.

scholarly journals Determinants of Weight Loss prior to Diagnosis in Inflammatory Bowel Disease: A Retrospective Observational Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Yasser Elsherif ◽  
Christopher Alexakis ◽  
Michael Mendall
Keyword(s):  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Bowel Disease ◽  
Demographic Variables ◽  
Age At Diagnosis ◽  
Factors Associated ◽  
Younger Age ◽  
History Of ◽  
Inflammatory Bowel ◽  
Ileal Disease

Aims. To identify prevalence, severity, and environmental determinants of weight loss in inflammatory bowel disease (IBD) patients just prior to time of formal diagnosis.Methodology. IBD patients attending outpatient clinic were questioned about weight loss prior to diagnosis and other environmental and demographic variables. The percentage BMI loss was calculated for each subject and factors associated with weight loss were determined.Results. Four hundred and ninety-four subjects were recruited (237 cases of Crohn’s disease (CD) and 257 cases of ulcerative colitis (UC)). Overall, 57% of subjects with CD and 51% of subjects with UC experienced significant weight loss prior to diagnosis (>5% BMI loss). Younger age at diagnosis and history of previous IBD surgery were significantly associated with both lower BMI at diagnosis and increased weight loss prior to diagnosis. In CD patients, increasing age at diagnosis was inversely associated with weight loss prior to diagnosis. Ileal disease was a risk factor of weight loss, whereas prior appendectomy was associated with reduced risk of weight loss.Conclusions. Weight loss is a significant problem for many IBD patients at presentation, especially in younger age and CD with ileal involvement. Appendectomy is associated with diminished weight loss.

scholarly journals MON-587 A Case of Pseudoglucagonoma Syndrome Post Bariatric Surgery

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sapna Raghunathan ◽  
Padmaja Akkireddy
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Nutritional Deficiencies ◽  
Laboratory Evaluation ◽  
Dermatology Clinic ◽  
Necrolytic Migratory Erythema ◽  
History Of ◽  
Inflammatory Bowel ◽  
Post Bariatric Surgery

Abstract Introduction Necrotizing migratory erythema (NME) is hallmark clinical finding of Glucagonoma, an islet cell tumor of the pancreas. NME can sometimes be seen in the absence of Glucagonoma, a condition referred to as Pseudo-glucagonoma syndrome(PGS). We report a case of NME associated with severe nutritional deficiency. Case 48 y/o female presented to dermatology clinic with diffuse itchy rash of 6 months duration. The rash started on the arms and spread to involve lower abdomen, legs and perioral area. It was unresponsive to both topical and high dose PO steroids. Biopsy of the rash showed confluent parakeratosis and mild spongiosis secondary to nutritional deficiencies vs NME. Her medical history was significant for Nissen fundoplication 20 years ago with a revision to Roux-en Y gastric by-pass, 6 years ago. She did not have a history of Diabetes or Inflammatory Bowel Disease. She was not on any vitamin supplementation, as she did not follow up for post bariatric care. On admission to the hospital for sepsis from secondary infection of the rash, diffuse erythematous, eczematous papules and plaques were noted on bilateral forearms, thighs, calves, buttocks and ankles. She also had perioral erythema and fissuring. Laboratory evaluation showed low prealbumin and multiple nutritional deficiencies including copper, zinc, vitamin B6, Vitamin D, ferritin. Her HbA1c was 5.8 % and fasting glucagon levels were normal. Her liver function was initially normal but later developed transaminitis from septic shock. She was started on enteral feeds with nutritional supplementation. This resulted in significant improvement of her rash with correction of underlying nutritional deficiencies. Discussion NME in the absence of Glucagonoma is extremely rare and is seen in hepatic cirrhosis, malabsorption disorders, inflammatory bowel disease and nutritional deficiencies including zinc deficiency, Pellagra, Kwashiorkor. Though the exact mechanism for NME in these conditions is unclear. It is postulated that unabsorbed nutrients in the gut lumen are potent stimulators of enteroglucagon which in turn mediates the development of NME. The treatment of NME associated with PGS is to correct the underlying cause. Our patient had history of gastric bypass surgery and did not get routine post bariatric care. She presented with multiple nutritional deficiencies which likely caused NME. It is important to recognize that post bariatric surgery, patients are at risk for both macro and micronutrient deficiencies and hence need frequent nutrition assessment, supplementation and monitoring. References Tierney EP, Badger J. Etiology and pathogenesis of necrolytic migratory erythema: review of the literature. MedGenMed 2004

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

2017 ◽  
Vol 152 (5) ◽  
pp. S972
Author(s):  
Ryan C. Ungaro ◽  
Helena L. Chang ◽  
Lídia M. Roque Ramos ◽  
Rebecca Fausel ◽  
Joana Torres ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Past History ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
New Onset

Application of Ultrasound Elastography for Assessing Intestinal Fibrosis in Inflammatory Bowel Disease: Fiction or Reality?

2020 ◽  
Vol 21 ◽  
Author(s):  
Roberto Gabbiadini ◽  
Eirini Zacharopoulou ◽  
Federica Furfaro ◽  
Vincenzo Craviotto ◽  
Alessandra Zilli ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Sample Size ◽  
Bowel Disease ◽  
Small Sample Size ◽  
Shear Wave Elastography ◽  
Small Sample ◽  
Ultrasound Elastography ◽  
Invasive Technique ◽  
Intestinal Fibrosis ◽  
Inflammatory Bowel

Background: Intestinal fibrosis and subsequent strictures represent an important burden in inflammatory bowel disease (IBD). The detection and evaluation of the degree of fibrosis in stricturing Crohn’s disease (CD) is important to address the best therapeutic strategy (medical anti-inflammatory therapy, endoscopic dilation, surgery). Ultrasound elastography (USE) is a non-invasive technique that has been proposed in the field of IBD for evaluating intestinal stiffness as a biomarker of intestinal fibrosis. Objective: The aim of this review is to discuss the ability and current role of ultrasound elastography in the assessment of intestinal fibrosis. Results and Conclusion: Data on USE in IBD are provided by pilot and proof-of-concept studies with small sample size. The first type of USE investigated was strain elastography, while shear wave elastography has been introduced lately. Despite the heterogeneity of the methods of the studies, USE has been proven to be able to assess intestinal fibrosis in patients with stricturing CD. However, before introducing this technique in current practice, further studies with larger sample size and homogeneous parameters, testing reproducibility, and identification of validated cut-off values are needed.

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