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Short-Term Outcomes of Inflammatory Bowel Disease after Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy

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Published:1st Jun 2019

Author: Heshmati K, Lo T, Tavakkoli A, Sheu E.

Source: Journal of the American College of Surgeons

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Ref.:J Am Coll Surg. 2019. pii: S1072-7515(19)30153-X.

DOI:10.1016/j.jamcollsurg.2019.01.021

Short-Term Outcomes of Inflammatory Bowel Disease after Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Background: Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most effective therapies for obesity and may have beneficial effects on the immune system. Therefore, we compared RYGB versus SG outcomes in the patients with IBD.

Study design: In this retrospective cohort study, we identified 54 patients with either Crohn's Disease (CD; n=31) or Ulcerative Colitis (UC; n=23) diagnosed before bariatric surgery between 2000-2017. 19 patients underwent RYGB and 35 patients underwent SG.

Results: Patients presenting for RYGB and SG had similar age (46.2±9.5 vs. 47.2±12.3), pre-operative BMI (48.5±7.7 vs. 44.9±7.3 lb/in2) and IBD status, as measured by medications. Both surgeries led to significant weight loss at 1-year. Following RYGB and SG, there were no significant differences in the proportion of patients with UC who had improved (27% vs. 8%), unchanged (64% vs. 92%), or worsened (9% vs. 0%) IBD-medication requirements, respectively. Similar analysis in the patients with CD showed no significant differences in the proportion who had improved (37.5% vs. 44%), or unchanged (25% vs. 52%) IBD-medication requirements following RYGB and SG, respectively. However, there was a significant difference in the proportion of patients who had worsened CD following RYGB compared to SG (37.5% vs. 4%; p=0.016). There was a greater rate of surgical complications following RYGB compared to SG (26% vs. 3%; p=0.02).

Conclusions: A sizable proportion of patients experienced improvements in IBD post-bariatric surgery. However, in CD patients, RYGB was associated with a significantly greater number of patients with increased IBD-medication requirements. SG led to less weight loss but had a lower rate of severe complications compared to RYGB. In patients with IBD, particularly CD, SG may be the safer surgery.

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