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Lojou M, Sahakian N, Dutour A, Vanbiervliet G, Bege T, Gaborit B. Celiac Disease and Obesity: Is Bariatric Surgery an Option? Obes Surg 2021; 30:2791-2799. [PMID: 32314256 DOI: 10.1007/s11695-020-04607-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Celiac disease is an immune-mediated enteropathy associated with malabsorptive syndrome and fat-soluble vitamin deficiencies. Celiac disease affects 1% of individuals but is largely underdiagnosed, as its multifaceted clinical presentations create challenging diagnostic scenarios. With the rise of the obesity epidemic, doctors are increasingly seeing celiac disease patients with overweight or obesity, which raises the question of bariatric surgery. However, few studies so far have investigated bariatric surgery in this patient population. Here, we provide a comprehensive review of the literature on celiac disease, its nutritional consequences and complications, and we discuss the possible impact of bariatric surgery on weight loss, nutritional deficiencies, response to gluten-free diet, and long-term post-operative complications. We also review the effect of bariatric surgery on the incidence of celiac disease.
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Affiliation(s)
- Manon Lojou
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Nicolas Sahakian
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France
| | | | - Thierry Bege
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.,IFSTTAR, LBA, Aix-Marseille University, Marseille, France
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique-Hôpitaux de Marseille, Marseille, France. .,INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France. .,Department of Endocrinology, Metabolic Disease and Nutrition, Pole ENDO, Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
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Freeman LM, Strong AT, Sharma G, Punchai S, Rodriguez JH, Kirby DF, Kroh M. Implications of Celiac Disease Among Patients Undergoing Gastric Bypass. Obes Surg 2019; 28:1546-1552. [PMID: 29235012 DOI: 10.1007/s11695-017-3046-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well studied in the setting of pre-existing celiac disease. MATERIALS AND METHODS Patients who underwent Roux-en-Y gastric bypass (RYGB) from January 2002 to December 2015 were retrospectively reviewed for either diagnosis of or serum testing for celiac disease. Identified patients were re-reviewed for adherence to American Gastroenterological Association (AGA) diagnostic criteria. Patient demographics, operative data, and post-operative weight loss and nutritional parameters were collected. RESULTS Of the > 12,000 patients who underwent bariatric surgery during this study period, there were 342 patients that had abnormal serology or pathology results. Expert review confirmed three patients (0.8%) with celiac disease diagnosed before RYGB procedure. All were female, with an average age of 33 years and a mean BMI of 44.07 kg/m2. At the time of surgery, two of the three patients were following a gluten-free diet. At 6 months follow-up, mean % excess weight loss was 76.5%. The patients following a gluten-free diet preoperatively continued post-operatively. No patients were anemic nor had vitamin B12 or iron deficiencies at 12-month follow-up. Two patients had vitamin D insufficiencies and responded to daily oral supplementation. CONCLUSION Though many bariatric patients may carry a presumptive diagnosis of celiac disease, a small percentage of these meet AGA diagnostic criteria. RYGB appears safe in this population with comparable weight loss in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.
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Affiliation(s)
- Lindsey M Freeman
- Case Western Reserve School of Medicine, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH, 44106, USA.
| | - Andrew T Strong
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Gautam Sharma
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Suriya Punchai
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - John H Rodriguez
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Donald F Kirby
- Center for Human Nutrition, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Matthew Kroh
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Bazerbachi F, Sawas T, Vargas EJ, Haffar S, Deepak P, Kisiel JB, Loftus EV, Abu Dayyeh BK. Bariatric Surgery Is Acceptably Safe in Obese Inflammatory Bowel Disease Patients: Analysis of the Nationwide Inpatient Sample. Obes Surg 2018; 28:1007-1014. [PMID: 29019151 DOI: 10.1007/s11695-017-2955-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of obesity in patients with inflammatory bowel disease (IBD) has increased over the past decades. Data to support the safety of bariatric surgery (BAR) in IBD remain scarce. Our aim was to evaluate the safety and early postoperative complications of BAR in IBD patients. METHODS We used the Nationwide Inpatient Sample (NIS) 2011, 2012, and 2013 to perform a cohort study. The study group was all hospitalized patients between ages 18-90 years who underwent BAR with a discharge diagnosis of IBD as per the Ninth International Classification of Diseases codes (ICD-9). Adults who underwent BAR without ICD-9 codes of IBD were identified as the comparison group. Complications were compared using multivariate logistic regression analysis. RESULTS We identified 314,864 adult patients who underwent BAR between 2011 and 2013. Mean age was 45.5 ± 0.11 years, and 79% were females. Seven hundred and ninety patients had underlying IBD; 459 had Crohn's disease and 331 had ulcerative colitis. The remaining patients formed the comparison group. Mean length of hospital stay (LOS) was longer in the IBD group by 1 day (p = 0.01). The IBD group had a significantly higher risk of perioperative small bowel obstruction (SBO) (adjusted odds ratio, 4.0; 95%, CI; 2.2-7.4). Other technical and systemic complications were similar between the two groups, with no mortality reported in the IBD group. CONCLUSIONS BAR in IBD patients has an acceptable safety profile, with immeditae risk limited to perioperative SBO and an apparently low risk of mortality or other major immediate postoperative complications.
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Affiliation(s)
- Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tarek Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samir Haffar
- Digestive Center for Diagnosis & Treatment, 29 Ayar Street, Damascus, Syrian Arab Republic
| | - Parakkal Deepak
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Gastroenterology and Hepatology, Washington University School of Medicine in St. Louis, St Louis, MO, 63110, USA
| | - John B Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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