Loading ...

TOPLINE:

Among patients with severe obesity, metabolic and bariatric surgery (MBS) was associated with a lower short-term risk for inflammatory bowel disease (IBD), but vertical sleeve gastrectomy (VSG) was linked to an increased long-term risk, particularly for ulcerative colitis.

METHODOLOGY:

• Researchers conducted a retrospective study using a US administrative health claims database to evaluate the incidence of newly diagnosed IBD after MBS in patients with severe obesity.
• The study included 100,832 patients with severe obesity (median age, 44 years; 76.9% female; BMI ≥ 40) who underwent MBS between 2012 and 2021 and 376,855 matched control patients with severe obesity who did not undergo MBS.
• The MBS group underwent elective Roux-en-Y gastric bypass (RYGB; 29.7%) or VSG (70.3%), with severe obesity documented within 1 year before surgery; the index date was the surgery date for the MBS group and the earliest documentation of severe obesity for control patients.
• Incident IBD required both diagnostic claims and prescription of an IBD medication; events were analyzed by timing, occurring either < 3 years or ≥ 3 years after the index date.
• IBD severity was assessed using healthcare utilization-based proxies, including IBD medications (steroids, antimetabolites, and biologics or small molecules), IBD-related hospitalizations, and IBD-related surgeries.

TAKEAWAY:

• During the first 3 years of follow-up, those who underwent MBS had a 24% lower risk for developing IBD and a 51% lower risk for ulcerative colitis than control patients (P < .05 for both).
• VSG was associated with a 54% lower risk for Crohn’s disease, whereas RYGB was associated with a 78% lower risk for ulcerative colitis within 3 years of surgery (P < .05 for both).
• At 3 years or later, patients who underwent VSG had a more than twofold higher risk for new-onset IBD (adjusted hazard ratio [aHR], 2.28; P = .04), driven primarily by a more than threefold increased risk for ulcerative colitis (aHR, 3.22; P = .03).
• Colectomy was more frequent among patients who developed ulcerative colitis after MBS than among those who did not undergo MBS (8.7% vs 1.6%; P = .03), although overall IBD medication use did not differ significantly between groups.

IN PRACTICE:

“This information could not only help stratify those patients preparing for MBS who are at risk for IBD and whose gastrointestinal symptoms may need further evaluation before surgery but also help contribute to a better general understanding of IBD pathogenesis,” the authors wrote.

SOURCE:

This study was led by Antoinette Pusateri, MD, The Ohio State University Wexner Medical Center, Columbus, Ohio. It was published online in Obesity Surgery.

LIMITATIONS:

Researchers could not quantify postoperative weight loss or assess visceral adiposity. Residual confounding may have remained despite propensity matching. IBD severity was not assessed using endoscopic, radiologic, histologic, and biomarker measures, and clinical factors such as family history and severity of coexisting autoimmune disease were not captured.

DISCLOSURES:

No funding information was reported. Some authors disclosed serving on advisory committees, advisory boards, or boards of directors for a pharmaceutical company and a foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.