Sleeve gastrectomy may be safer than gastric bypass for IBD patients

By Anne Harding

NEW YORK (Reuters Health) - 28/2/2019

Most obese patients with inflammatory bowel disease (IBD) fare well after bariatric surgery, but gastric bypass could make Crohn's disease harder to control, new research suggests.

"For a patient with IBD who is obese, sleeve gastrectomy is probably a safer option and a more effective option, both in terms of weight loss and in terms of potential benefit for IBD," Dr. Eric Sheu of Brigham and Women's Hospital in Boston, the study's senior author, told Reuters Health by phone. The findings were published online February 21 in the Journal of the American College of Surgeons.

A small but growing number of IBD patients are candidates for weight-loss surgery, which may have immune system benefits, Dr. Sheu noted.

He and his colleagues looked retrospectively at 31 patients with CD and 23 with ulcerative colitis (UC) who underwent bariatric surgery from 2000 to 2017. Nineteen had Roux-en-Y gastric bypass (RYGB) and 35 underwent sleeve gastrectomy (SG).

One year after surgery, BMI had dropped by 15 kg/m2 with RYBG and 11.5 kg/m2 with SG (P=0.2). Percent of total body weight lost at one year was 31% versus 23%, respectively (P<0.01).

There were no significant differences between IBD medication requirements after RYBG or SG in UC patients. For CD patients, the proportion of patients who did not need IBD medication or had stable or lower medication needs was also similar for both procedures.

But 37.5% of CD patients who underwent RYBG had increased medication requirements, versus 4% of those who had SG (P=0.04). Surgical complications also occurred more frequently with RYGB than with SG (26% vs. 3%, P=0.02).

The findings provide "a little more hard evidence that gastric bypass is probably riskier overall and also in terms of potentially making your IBD harder to control," Dr. Sheu said.

He and his colleagues are currently investigating whether bariatric surgery has effects on the immune system independent of weight loss.

SOURCE: https://bit.ly/2NxTNKa

J Am Coll Surg 2019.

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