Implications of Celiac Disease Among Patients Undergoing Gastric Bypass
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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.
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.
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.
KeywordsCeliac disease Bariatric surgery Roux-en-Y Gastric bypass Nutritional deficiency Malabsorption
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.
- 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
- 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
- 20.Tsui JM, Thompson JS, Kothari VM, et al. Bariatric procedures unmasking celiac disease. J Obes Bariatr. 2014;1:3.Google Scholar
- 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
- 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