P192 The impact of bariatric surgery on the course of inflammatory bowel disease
R. Fausel*1, L. Roque Ramos1, 2, R. Ungaro1, J. Torres1, J.-F. Colombel1
1Icahn School of Medicine at Mount Sinai, Department of Medicine, New York, New York, United States, 2Hospital Garcia de Orta, Gastroenterology, Almada, Portugal
A significant number of inflammatory bowel disease (IBD) patients are overweight or obese; 32%–46% of patients with Crohn’s disease in the USA have a body mass index (BMI) > 25 kg/m2. Some of these patients may be candidates for bariatric surgery (BS), but there are limited data on its safety in IBD; BS leads to profound changes in the gut metabolism, including changes in the microbiota that may affect IBD behaviour and activity. The aim of this study was to evaluate the effect of BS on the course of IBD in patients seen at a tertiary centre.
From an institutional data warehouse, we identified patients with a confirmed diagnosis of IBD preceding BS. We looked at change in disease phenotype and disease course following BS. Poor outcomes were assessed and included BS-related death, IBD-related surgery, new or worsening IBD-related complication, IBD-related hospitalisation, or need for new or increased immunosuppressive medications for worsening IBD activity. We looked at the influence of demographic and disease variables on the risk of poor outcomes using Chi-square and McNemar log-rank tests.
Included were 18 patients (13 female): 11 patients had CD and 7 had UC/indeterminate colitis. The median age at the time of surgery was 49, and median BMI before surgery was 47. Median time to BS after diagnosis was 6 years (range 4–41 years). 61% of patients underwent gastric lap band (6 CD, 5 UC), 11% sleeve gastrectomy (2 CD, 0 UC), and 28% Roux-en-Y gastric bypass (3 CD, 2 UC). After a median follow-up period of 7 years (range 1–16 years), disease phenotype did not change. Further, 7 patients (39%) developed a poor outcome, only one of which occurred within the first year (a patient with UC who required new infliximab therapy); 2 CD patients were hospitalised for an IBD-related complication, and 3 CD patients (including these 2) required resection surgery. Biologic use was 17% pre-operatively and 39% after surgery (p = 0.212); 6 patients required an increase in immunosuppressive therapy, and 3 patients were eventually able to reduce their medications. No deaths were observed. Pre-operative disease features, tobacco use, and demographic factors had no statistically significant effect on the risk of poor outcome, but patients with a higher post-op BMI tended to have increased risk of disease worsening (1 of 7 in BMI < 35; 6 of 11 in BMI > 35), although this did not reach statistical significance (p = 0.15).
In this series of patients from a tertiary care centre, BS was safely performed in IBD. However, there may be an increased risk of disease worsening in patients with higher post-op BMI. Larger prospective studies are needed to assess the effect of bariatric surgery on the course of IBD.