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

Neto MBB1, Gregory MH2, Ramos GP1, Bazerbachi F1, Bruining DH1, Abu Dayyeh BK1, Kushnir VM2, Raffals LE1, Ciorba MA2,3, Loftus EV1, Deepak P2,3. Inflamm Bowel Dis. 2019 Oct 15. pii: izz236. doi: 10.1093/ibd/izz236. [Epub ahead of print]


Author information

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.

Washington University Inflammatory Bowel Diseases Center, Saint Louis, Missouri, USA.


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.

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