Bariatric surgery in morbidly obese patients with inflammatory bowel disease: A systematic review

Saeed Shoar; Sayed Shahabuddin Hoseini; Mohammad Naderan; Habibollah Mahmoodzadeh; Fung Ying Man; Nasrin Shoar; Motahar Hosseini; Shahram Bagheri-Hariri

doi:10.1016/j.soard.2016.10.017

Bariatric surgery in morbidly obese patients with inflammatory bowel disease: A systematic review

Surg Obes Relat Dis. 2017 Apr;13(4):652-659. doi: 10.1016/j.soard.2016.10.017. Epub 2016 Oct 25.

Authors

Saeed Shoar¹, Sayed Shahabuddin Hoseini², Mohammad Naderan², Habibollah Mahmoodzadeh³, Fung Ying Man⁴, Nasrin Shoar⁵, Motahar Hosseini⁶, Shahram Bagheri-Hariri⁷

Affiliations

¹ Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: ssht84@yahoo.com.
² School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
⁴ College of Medicine, Saint George's Medical School, Grenada.
⁵ School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
⁶ Department of Surgery, Saint Agnes Hospital, Baltimore, MD.
⁷ Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

PMID: 27986584
DOI: 10.1016/j.soard.2016.10.017

Abstract

Backgrounds: With increased prevalence of obesity, the number of inflammatory bowel disease (IBD) patients suffering from morbid obesity has raised. It is not clear yet if bariatric surgery is a safe and effective option in this population.

Objectives: Our systematic review aims to summarize the available literature on the safety and efficacy of bariatric surgery in morbidly obese patients with IBD.

Setting: University hospital, Iran.

Methods: A PubMed/MEDLINE search was performed to identify studies reporting the outcome of morbidly obese IBD patients. Postoperative outcome of IBD patients after bariatric surgery were pooled for early and late complications, change of IBD status, and medication alteration.

Results: A total of 7 studies reported post-bariatric surgery outcomes of 43 morbidly obese IBD patients (31 females, 11 males) with an age ranging from 30 to 64 years and a body mass index from 35.7 to 71 kg/m². Of these, 25 suffered Crohn's disease (CD) (58.2%) and 18 were ulcerative colitis (UC) patients (41.8%). The small bowel was the most common involved gastrointestinal segment in 27.3% of patients. CD patients more commonly underwent sleeve gastrectomy (72%), while UC patients similarly underwent sleeve gastrectomy and Roux-en-Y gastric bypass (44.4%). After a follow-up of 8 to 77 months, IBD patients lost up to 71.4%±5.9% of excess weight and 14.3 kg/m²±5.7 kg/m² of body mass index. There were 9 early (21.4%) and 10 late (23.8%) postoperative complications related to the bariatric procedure. IBD remitted in 20 patients (47.6%), improved in 2 patients (4.8%), but exacerbated in 7 patients (16.7%).

Conclusions: Although available data on morbidly obese patients with IBD is scarce, bariatric surgery seems to be a safe and effective option for these patients with no added morbidity or mortality. Further studies are necessary to confirm this data.

Keywords: Bariatric surgery; Inflammatory bowel diseases; Morbid obesity; Review.

Publication types

Review
Systematic Review

MeSH terms

Bariatric Surgery*
Body Mass Index
Global Health
Humans
Inflammatory Bowel Diseases / complications*
Inflammatory Bowel Diseases / surgery
Morbidity / trends
Obesity, Morbid / complications
Obesity, Morbid / surgery*
Postoperative Complications / epidemiology*
Treatment Outcome
Weight Loss*