Implications of Celiac Disease Among Patients Undergoing Gastric Bypass

  • Lindsey M. Freeman
  • Andrew T. Strong
  • Gautam Sharma
  • Suriya Punchai
  • John H. Rodriguez
  • Donald F. Kirby
  • Matthew Kroh
Original Contributions
  • 45 Downloads

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.

Keywords

Celiac disease Bariatric surgery Roux-en-Y Gastric bypass Nutritional deficiency Malabsorption 

Notes

Compliance with Ethical Standards

Conflict of Interest

Lindsey M. Freeman has no financial ties or financial disclosures pertinent to this work.

Andrew T Strong has no financial ties or financial disclosures pertinent to this work.

Gautam Sharma has no financial ties or financial disclosures pertinent to this work.

Suriya Punchai has no financial ties or financial disclosures pertinent to this work.

John H Rodriguez has no financial ties or financial disclosures pertinent to this work. He has received research funding from Pacira Pharmaceuticals and Intuitive Surgical.

Donald F Kirby has no financial ties or financial disclosures pertinent to this work.

Matthew Kroh has no financial ties or financial disclosures pertinent to this work. He has served as a consultant to Medtronic, Levita Magnetics, and Cook and has received research funding from Cook.

Ethical Approval Statement

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

Informed Consent Statement

Does not apply.

References

  1. 1.
    Diamanti A, Capriati T, Basso M, et al. Celiac disease and overweight in children: an update. Nutrients. 2014;6(1):207–20.  https://doi.org/10.3390/nu6010207.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sanders DS, Hopper AD, Azmy IAF, et al. Association of Adult Celiac Disease with Surgical Abdominal Pain: a case-control study in patients referred to secondary care. Ann Surg. 2005;242(2):201–7.  https://doi.org/10.1097/01.sla.0000171301.35513.cf.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Green PHR. The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology. 2005;128(4):S74–8.  https://doi.org/10.1053/j.gastro.2005.02.016.CrossRefPubMedGoogle Scholar
  4. 4.
    Kochhar GS, Singh T, Gill A, et al. Celiac disease: managing a multisystem disorder. Cleve Clin J Med. 2016;83(3):217–27.  https://doi.org/10.3949/ccjm.83a.14158.CrossRefPubMedGoogle Scholar
  5. 5.
    Fasano A, Catassi C. Celiac disease. N Engl J Med. 2012;367(25):2419–26.  https://doi.org/10.1056/NEJMcp1113994.CrossRefPubMedGoogle Scholar
  6. 6.
    Admou B, Essaadouni L, Krati K, et al. Atypical celiac disease: from recognizing to managing. Gastroenterol Res Pract. 2012;2012:1–9.  https://doi.org/10.1155/2012/637187.CrossRefGoogle Scholar
  7. 7.
    Tucker E, Rostami K, Prabhakaran S, et al. Patients with coeliac disease are increasingly overweight or obese on presentation. J Gastrointestin Liver Dis. 2012;21:11–5.PubMedGoogle Scholar
  8. 8.
    Kabbani TA, Goldberg A, Kelly CP, et al. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment Pharmacol Ther. 2012;35(6):723–9.  https://doi.org/10.1111/j.1365-2036.2012.05001.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Ukkola A, Mäki M, Kurppa K, et al. Changes in body mass index on a gluten-free diet in coeliac disease: a nationwide study. Eur J Intern Med. 2012;23(4):384–8.  https://doi.org/10.1016/j.ejim.2011.12.012.CrossRefPubMedGoogle Scholar
  10. 10.
    Dickey W, Kearney N. Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet. Am J Gastroenterol. 2006;101(10):2356–9.  https://doi.org/10.1111/j.1572-0241.2006.00750.x.CrossRefPubMedGoogle Scholar
  11. 11.
    Cheng J, Brar PS, Lee AR, et al. Body mass index in celiac disease: beneficial effect of a gluten-free diet. J Clin Gastroenterol. 2010;44(4):267–71.  https://doi.org/10.1097/MCG.0b013e3181b7ed58.CrossRefPubMedGoogle Scholar
  12. 12.
    Murray JA, Van Dyke C, Plevak MF, et al. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2003;1:19–27.Google Scholar
  13. 13.
    Theethira TG, Dennis M. Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Dig Dis Basel Switz. 2015;33(2):175–82.  https://doi.org/10.1159/000369504.CrossRefGoogle Scholar
  14. 14.
    Aminian A, Andalib A, Ver MR, et al. Outcomes of bariatric surgery in patients with inflammatory bowel disease. Obes Surg. 2016;26(6):1186–90.  https://doi.org/10.1007/s11695-015-1909-y.CrossRefPubMedGoogle Scholar
  15. 15.
    Deveney CW. Bariatric surgery in severely obese patients with inflammatory bowel disease: a systematic review. Surg Obes Relat Dis. 2017;13(4):659–60.  https://doi.org/10.1016/j.soard.2016.11.024.CrossRefPubMedGoogle Scholar
  16. 16.
    Cuenca-Abente F, Nachman F, Bai JC. Diagnosis of celiac disease during pre-operative work-up for bariatric surgery. Acta Gastroenterol Latinoam. 2012;42(4):321–4.PubMedGoogle Scholar
  17. 17.
    Rubio-Tapia A, Hill ID, Kelly CP, et al. American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656–76. quiz 677CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606.  https://doi.org/10.1007/s11695-015-1645-3.CrossRefPubMedGoogle Scholar
  19. 19.
    Thompson JS, Thompson DS, Meyer A. Surgical aspects of celiac disease. Am Surg. 2015;81(2):157–60.PubMedGoogle Scholar
  20. 20.
    Tsui JM, Thompson JS, Kothari VM, et al. Bariatric procedures unmasking celiac disease. J Obes Bariatr. 2014;1:3.Google Scholar
  21. 21.
    de’Angelis N, Carra MC, Vincenzi F. Gluten-free diet in obese patients with celiac disease: an enemy of the bariatric surgeon? Obes Surg. 2012;22(6):995–6.  https://doi.org/10.1007/s11695-012-0626-z.CrossRefPubMedGoogle Scholar
  22. 22.
    Pané A, Orois A, Careaga M, et al. Clinical onset of celiac disease after duodenal switch: a case report. Eur J Clin Nutr. 2016;70(9):1078–9.  https://doi.org/10.1038/ejcn.2016.65.CrossRefPubMedGoogle Scholar
  23. 23.
    Sawaya R, Jaffe J, Friedenberg L, et al. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab. 2012;13(9):1345–55.  https://doi.org/10.2174/138920012803341339.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Fernandez-Banares F, Monzon H, Forne MA. Short review of malabsorption and anemia. World J Gastroenterol. 2009;15(37):4644–52.  https://doi.org/10.3748/wjg.15.4644.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Wierdsma N, van Bokhorst-de van der Schueren M, Berkenpas M, et al. Vitamin and Mineral Deficiencies Are Highly Prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975–92.  https://doi.org/10.3390/nu5103975.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Malterre T. Digestive and nutritional considerations in celiac disease: could supplementation help? Altern Med Rev J Clin Ther. 2009;14:247–57.Google Scholar
  27. 27.
    Xanthakos SA. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr Clin N Am. 2009;56(5):1105–21.  https://doi.org/10.1016/j.pcl.2009.07.002.CrossRefGoogle Scholar
  28. 28.
    Lo Menzo E, Cappellani A, Zanghì A, et al. Nutritional implications of obesity: before and after bariatric surgery. Bariatr Surg Pract Patient Care. 2014;9:9–17.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Forrest KYZ, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res N Y N. 2011;31(1):48–54.  https://doi.org/10.1016/j.nutres.2010.12.001.CrossRefGoogle Scholar
  30. 30.
    Vieth R. What is the optimal vitamin D status for health? Prog Biophys Mol Biol. 2006;92(1):26–32.  https://doi.org/10.1016/j.pbiomolbio.2006.02.003.CrossRefPubMedGoogle Scholar
  31. 31.
    Dawson-Hughes B, Mithal A, Bonjour J-P, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found U S A. 2010;21:1151–4.CrossRefGoogle Scholar
  32. 32.
    Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53–8.  https://doi.org/10.1210/jc.2010-2704.CrossRefPubMedGoogle Scholar
  33. 33.
    Manson JE, Brannon PM, Rosen CJ, et al. Vitamin D deficiency—is there really a pandemic? N Engl J Med. 2016;375(19):1817–20.  https://doi.org/10.1056/NEJMp1608005.CrossRefPubMedGoogle Scholar
  34. 34.
    American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc. 2014;62(1):147–52.  https://doi.org/10.1111/jgs.12631.CrossRefGoogle Scholar
  35. 35.
    Barone M, Della Valle N, Rosania R, et al. A comparison of the nutritional status between adult celiac patients on a long-term, strictly gluten-free diet and healthy subjects. Eur J Clin Nutr. 2016;70(1):23–7.  https://doi.org/10.1038/ejcn.2015.114.CrossRefPubMedGoogle Scholar
  36. 36.
    Sonti R, Green PHR. Celiac disease: obesity in celiac disease. Nat Rev Gastroenterol Hepatol. 2012;9(5):247–8.  https://doi.org/10.1038/nrgastro.2012.64.CrossRefPubMedGoogle Scholar
  37. 37.
    Semeraro LA, Barwick KW, Gryboski JD. Obesity in celiac sprue. J Clin Gastroenterol. 1986;8(2):177–80.  https://doi.org/10.1097/00004836-198604000-00015.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Lindsey M. Freeman
    • 1
  • Andrew T. Strong
    • 2
  • Gautam Sharma
    • 2
  • Suriya Punchai
    • 2
  • John H. Rodriguez
    • 2
  • Donald F. Kirby
    • 3
    • 4
  • Matthew Kroh
    • 2
    • 4
    • 5
  1. 1.Case Western Reserve School of MedicineCase Western Reserve UniversityClevelandUSA
  2. 2.Section of Surgical Endoscopy, Department of General SurgeryCleveland ClinicClevelandUSA
  3. 3.Center for Human Nutrition, Department of GastroenterologyCleveland ClinicClevelandUSA
  4. 4.Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  5. 5.Digestive Disease InstituteCleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates

Personalised recommendations