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Surgery and inflammatory bowel disease

Does bariatric surgery increase risk of inflammatory bowel disease?

A past history of bariatric surgery was associated with an increased risk of new-onset however, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD

There is a link between the development of inflammatory bowel disease (IBD) and a past history of bariatric surgery, according to researchers from Icahn School of Medicine at Mount Sinai, in New York. The study, ‘Bariatric surgery is associated with increased risk of new-onset inflammatory bowel disease: case series and national database study’, published in Alimentary Pharmacology & Therapeutics, sought to evaluate the association between bariatric surgery and new-onset IBD.

"While we do not think our findings should at all discourage or take away from the health benefits of bariatric surgery, since the absolute risk of developing IBD following bariatric surgery remains extremely small, we think this association highlights potential disease mechanisms and the need to carefully evaluate new gastrointestinal symptoms in patients with prior weight loss surgery," said senior author, Dr Jean-Frederic Colombel, of the Icahn School of Medicine. "Of note, another recent study from the Mayo Clinic had similar findings calling for the need for further prospective studies on this topic."

For the analysis, investigators first conducted a multi-institutional case series of patients with a history of IBD and bariatric surgery. A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified and reviewed. They next conducted a matched case-control study using medical and pharmacy claims database from 2008 to 2012. A total of 8,980 cases and 43,059 controls were included in the database analysis.

Most cases were women, had Roux-en-Y surgery years prior to diagnosis and few IBD-related complications. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new-onset IBD (OR 1.93, 95% CI 1.34-2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58-1.52).

The mechanism by which weight loss surgery may increase the risk of IBD is unclear, although it has been hypothesised that alterations in gut microbes following the surgery may play a role. In addition, weight loss surgery patients have elevated rates of vitamin D and bile salt deficiencies.

“Prospective studies are needed to confirm the association found in this analysis and delineate if certain types of weight loss surgeries have differential effects on risk of IBD,” the researchers concluded.

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