Sleeve gastrectomy - but not Roux-en-Y gastric bypass - was associated with improved disease-specific outcomes in patients with inflammatory bowel disease (IBD) and morbid obesity, according to the findings from a propensity matched cohort study by US researchers. This suggests that sleeve gastrectomy may be the preferred bariatric procedure for treating patients with IBD.
The study’s researchers from Case Western Reserve University, Cleveland, OH, said there is a growing body of data that suggest a negative impact of obesity on the disease status of IBD, and therefore it is important to understand the impact of anti-obesity interventions on the natural course of IBD. Furthermore, they noted that very few studies have evaluated IBD-specific outcomes after any anti-obesity interventions.
Therefore, this study was designed to evaluate the risk of disease-specific outcomes, including hospitalisation requiring intravenous steroid use or major IBD-related surgery in patients with IBD who underwent bariatric surgery, compared with patients who did not undergo bariatric surgery.
The researchers identified 233,988 patients with IBD in the database - 49,144 patients (21%) had obesity, of which 13,861 patients (28.2%) had morbid obesity. Four hundred eighty-two patients (3.4%) underwent bariatric surgery. (154 patients (32%) underwent RYGB and 328 patients (68%) underwent sleeve gastrectomy (SG). The mean BMI and body weight before bariatric surgery was 42.1±7.07kg/m2 and 268±55.1lbs, respectively. One-year after bariatric surgery the mean BMI and body weight was 34.4±6.9kg/m2 and 207+/-52.7lbs, respectively.
After propensity-score matching, the surgical cohort was at a lower risk of a composite of intravenous steroid use and IBD-related surgery, vs. the control cohort. A sub-group analysis based on IBD type found that there was a lower risk of a composite of IBD-related complications in the BS cohort with Crohn's Disease (CD) and ulcerative colitis (UC) vs. the control cohort.
In the secondary analysis, the surgical cohort had a lower risk for intravenous steroid use and oral steroids vs. with the control cohort. The researchers found no difference in the risk of all-cause mortality and IBD-related surgery. In total, 356 patients (74%) in the BS cohort that were biologically naive. After propensity-score matching, the surgical cohort had a lower risk of biological or small molecule therapy initiation vs. the control cohort.
The mean BMI one-year after sleeve gastrectomy was 36±6.8kg/m2 and after RYGB was 31.9±6.4 and after propensity score matching, they found sleeve gastrectomy was at a lower risk of a composite of IBD-related complications vs. the control cohort. In the sub-group analysis based on the type of IBD, the surgical cohort with UC and CD that underwent SG were at a lower risk of composite IBD-related complications. In addition, sleeve gastrectomy patients also had a lower risk of intravenous steroid use, oral steroids and biological or small molecule therapy initiation vs. the control cohort.
They also report that there was no difference in the risk of a composite of IBD-related complications between the surgical cohort that underwent RYGB and the control cohort. In the sub-group analysis based on the type of IBD, there was no difference in the risk of a composite of IBD-related complications in the surgical cohort with UC and CD that underwent RYGB vs. the control cohort. RYGB patients also had a lower risk of oral steroids. There was no difference in the risk of intravenous steroid use, IBD-related surgery, all-cause mortality and biological or small molecule therapy initiation between the 2 cohorts.
“We found that patients with IBD and morbid obesity who underwent bariatric surgery had a lower risk of disease-specific outcomes, which included a composite of intravenous steroid use and IBD-related surgery,” they concluded. “In our secondary analysis, we observed a lower risk of intravenous and oral steroid use and biological or small molecule therapy initiation in biological naive patients after bariatric surgery.”
The findings were reported in the paper, ‘Effect of Bariatric Surgery on Disease Outcomes in Patients With Inflammatory Bowel Disease - A US-based Propensity Matched Cohort Study’, published in the Journal of Clinical Gastroenterology. To access this paper, please click here
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