Obesity Surgery

, Volume 28, Issue 4, pp 1015–1024 | Cite as

Impact of Bariatric Surgery on Outcomes of Patients with Inflammatory Bowel Disease: a Nationwide Inpatient Sample Analysis, 2004–2014

Original Contributions

Abstract

Purpose

There is a paucity of data regarding the benefits of bariatric surgery in patients with inflammatory bowel disease (IBD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized patients with IBD.

Materials and Methods

The United States (US) National Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and IBD. Hospitalizations with a history of prior-bariatric surgery were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included renal failure, under-nutrition, thromboembolic events, strictures, fistulae, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery.

Results

Among 15,319 patients with a discharge diagnosis of IBD and morbid obesity, 493 patients (3.2%) had bariatric surgery. From 2004 to 2014, the proportion of obese IBD patients that underwent bariatric surgery declined (5.2 versus 3.1%). In a multivariable analysis, prior-bariatric surgery was associated with decreased IRR for renal failure, under-nutrition, and fistulae formation in morbidly obese IBD patients [(IRR 0.1; 95% CI 0.02–0.3; P < 0.001), (IRR 0.2; 95% CI 0.05–0.8; P = 0.03), and (IRR 0.1; 95% 0.2–08; P = 0.03), respectively]. Bariatric surgery did not influence mortality (P = 0.99).

Conclusions

Despite a gradual increase in morbid obesity among patients with IBD, there has been a decrease in proportion of overall bariatric surgeries. Bariatric surgery appears to reduce morbidity in obese patients with IBD.

Keywords

Inflammatory bowel disease (IBD) Crohn’s disease (CD) Ulcerative colitis (UC) Obesity Bariatric surgery Weight loss 

Notes

Author Contributions

Study concept and design: PS, TRM, BN; Acquisition and analysis of data: BN; Interpretation of data: PS, TRM, BN; Initial draft: PS; Critical revision of manuscript: TRM, BN. All authors approved the final draft submitted.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Harper JW, Zisman TL. Interaction of obesity and inflammatory bowel disease. World J Gastroenterol. 2016;22:7868–81.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12:720–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54 e42. quiz e30CrossRefPubMedGoogle Scholar
  4. 4.
    Long MD, Crandall WV, Leibowitz IH, et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:2162–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Chan SS, Luben R, Olsen A, et al. Body mass index and the risk for Crohn’s disease and ulcerative colitis: data from a European Prospective Cohort Study (the IBD in EPIC Study). Am J Gastroenterol. 2013;108:575–82.CrossRefPubMedGoogle Scholar
  6. 6.
    Mendall MA, Gunasekera AV, John BJ, et al. Is obesity a risk factor for Crohn’s disease? Dig Dis Sci. 2011;56:837–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Steed H, Walsh S, Reynolds N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes Facts. 2009;2:370–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Moran GW, Dubeau MF, Kaplan GG, et al. The increasing weight of Crohn’s disease subjects in clinical trials: a hypothesis-generatings time-trend analysis. Inflamm Bowel Dis. 2013;19:2949–56.CrossRefPubMedGoogle Scholar
  9. 9.
    Blain A, Cattan S, Beaugerie L, et al. Crohn’s disease clinical course and severity in obese patients. Clin Nutr. 2002;21:51–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Nic Suibhne T, Raftery TC, McMahon O, et al. High prevalence of overweight and obesity in adults with Crohn’s disease: associations with disease and lifestyle factors. J Crohns Colitis. 2013;7:e241–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Efron JE, Uriburu JP, Wexner SD, et al. Restorative proctocolectomy with ileal pouch anal anastomosis in obese patients. Obes Surg. 2001;11:246–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg. 2000;179:275–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Flores A, Burstein E, Cipher DJ, et al. Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci. 2015;60:2436–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.CrossRefPubMedGoogle Scholar
  15. 15.
    Romero-Talamas H, Daigle CR, Aminian A, et al. The effect of bariatric surgery on gout: a comparative study. Surg Obes Relat Dis. 2014;10:1161–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Romero-Talamas H, Aminian A, Corcelles R, et al. Psoriasis improvement after bariatric surgery. Surg Obes Relat Dis. 2014;10:1155–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Corcelles R, Daigle CR, Talamas HR, et al. Bariatric surgery outcomes in patients with systemic lupus erythematosus. Surg Obes Relat Dis. 2015;11:684–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Hass DJ, Brensinger CM, Lewis JD, et al. The impact of increased body mass index on the clinical course of Crohn’s disease. Clin Gastroenterol Hepatol. 2006;4:482–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Keidar A, Hazan D, Sadot E, et al. The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Surg Obes Relat Dis. 2015;11:132–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Navaneethan U, Parasa S, Venkatesh PG, et al. Impact of inflammatory bowel disease on post-cholecystectomy complications and hospitalization costs: a Nationwide Inpatient Sample study. J Crohns Colitis. 2013;7:e164–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Boutros M, Maron D. Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg. 2011;24:244–52.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Krane MK, Allaix ME, Zoccali M, et al. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg. 2013;216:986–96.CrossRefPubMedGoogle Scholar
  23. 23.
    Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality (AHRQ): Advancing Excellence in Health Care. https://www.ahrq.gov/research/data/hcup/index.html. Accessed 1 May 2017.
  24. 24.
    Population Estimates. United States Census Bureau. https://www.census.gov/popest/data/intercensal/national/nat2010.html. Accessed May 1 2017.
  25. 25.
    Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. National vital statistics report: from the Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Stat Syst. 1998;47:1–16, 20.Google Scholar
  26. 26.
    Karmiris K, Koutroubakis IE, Xidakis C, et al. Circulating levels of leptin, adiponectin, resistin, and ghrelin in inflammatory bowel disease. Inflamm Bowel Dis. 2006;12:100–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Yamamoto K, Kiyohara T, Murayama Y, et al. Production of adiponectin, an anti-inflammatory protein, in mesenteric adipose tissue in Crohn’s disease. Gut. 2005;54:789–96.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Valentini L, Wirth EK, Schweizer U, et al. Circulating adipokines and the protective effects of hyperinsulinemia in inflammatory bowel disease. Nutrition. 2009;25:172–81.CrossRefPubMedGoogle Scholar
  29. 29.
    Versini M, Jeandel PY, Rosenthal E, et al. Obesity in autoimmune diseases: not a passive bystander. Autoimmun Rev. 2014;13:981–1000.CrossRefPubMedGoogle Scholar
  30. 30.
    Yamamoto T, Shiraki M. Prevalence of overweight and obesity in patients with Crohn’s disease in Western countries and Japan. J Crohns Colitis. 2013;7:e192.CrossRefPubMedGoogle Scholar
  31. 31.
    Colombo F, Rizzi A, Ferrari C, et al. Bariatric surgery in patients with inflammatory bowel disease: an accessible path? Report of a case series and review of the literature. J Crohns Colitis. 2015;9:185–90.CrossRefPubMedGoogle Scholar
  32. 32.
    Causey MW, Johnson EK, Miller S, et al. The impact of obesity on outcomes following major surgery for Crohn’s disease: an American College of Surgeons National Surgical Quality Improvement Program assessment. Dis Colon rectum. 2011;54:1488–95.CrossRefPubMedGoogle Scholar
  33. 33.
    Ahn LB, Huang CS, Forse RA, et al. Crohn’s disease after gastric bypass surgery for morbid obesity: is there an association? Inflamm Bowel Dis. 2005;11:622–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Dodell GB, Albu JB, Attia L, et al. The bariatric surgery patient: lost to follow-up; from morbid obesity to severe malnutrition. Endocr Pract. 2012;18:e21–5.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Janczewska I, Nekzada Q, Kapraali M. Crohn’s disease after gastric bypass surgery. BMJ Case Rep. 2011;2011.  https://doi.org/10.1136/bcr.07.2010.3168
  36. 36.
    Nascimento AT, Rocha R, Coqueiro FG, et al. Does obesity complicate inflammatory bowel diseases? J Crohns Colitis. 2012;6:1041.CrossRefPubMedGoogle Scholar
  37. 37.
    Aminian A, Andalib A, Ver MR, et al. Outcomes of bariatric surgery in patients with inflammatory bowel disease. Obes Surg. 2016;26:1186–90.CrossRefPubMedGoogle Scholar
  38. 38.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefPubMedGoogle Scholar
  39. 39.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.CrossRefPubMedGoogle Scholar
  40. 40.
    Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;(8):CD003641.  https://doi.org/10.1002/14651858.CD003641.pub4
  41. 41.
    Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22:721–31.CrossRefPubMedGoogle Scholar
  42. 42.
    Khan S, Rock K, Baskara A, et al. Trends in bariatric surgery from 2008 to 2012. Am J Surg. 2016;211:1041–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Shoar S, Shahabuddin Hoseini S, Naderan M, et al. Bariatric surgery in morbidly obese patients with inflammatory bowel disease: a systematic review. Surg Obes Relat Dis. 2017;13:652–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Lieske JC, Mehta RA, Milliner DS, et al. Kidney stones are common after bariatric surgery. Kidney Int. 2015;87:839–45.CrossRefPubMedGoogle Scholar
  45. 45.
    Chang AR, Grams ME, Navaneethan SD. Bariatric surgery and kidney-related outcomes. Kidney Int Rep. 2017;2:261–70.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Seghieri M, Vitolo E, Giannini L, et al. Determinants of glomerular filtration rate following bariatric surgery in individuals with severe, otherwise uncomplicated, obesity: an observational, prospective study. Acta Diabetol. 2017;54:593–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Baumgart DC, Sandborn WJ. Crohn's disease. Lancet. 2012;380:1590–605.CrossRefPubMedGoogle Scholar
  48. 48.
    Barnes EL, Beery RM, Schulman AR, et al. Hospitalizations for acute myocardial infarction are decreased among patients with inflammatory bowel disease using a nationwide inpatient database. Inflamm Bowel Dis. 2016;22:2229–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Prabin Sharma
    • 1
  • Thomas R. McCarty
    • 2
  • Basile Njei
    • 3
  1. 1.Department of Internal MedicineYale-New Haven Health System - Bridgeport HospitalBridgeportUSA
  2. 2.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  3. 3.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA

Personalised recommendations