Safety and Efficacy of Bariatric Surgery in Inflammatory Bowel Disease Patients: a Systematic Review and Meta-analysis

Abstract

Background

The safety and efficacy of bariatric surgery in inflammatory bowel disease (IBD) patients is poorly understood. We conducted a systematic review and meta-analysis studying safety and efficacy of bariatric surgery in IBD patients as well as the impact of bariatric surgery on IBD course.

Methods

We conducted a comprehensive search of multiple databases (through September 2019) to identify studies that reported outcome of bariatric surgery in IBD patients. Outcomes assessed included the pooled rate of adverse events, change in medications after bariatric surgery, and 12-month excess weight loss (EWL) and body mass index (BMI) reduction after bariatric surgery.

Results

A total of 10 studies were included in final analysis. The pooled rate of early and late adverse events was 15.9% (95% CI, 9.3–25.9) and 16.9% (95% CI, 12.1–23.1), respectively. The rate of adverse events in Roux-en-Y gastric bypass was 45.6% (95% CI, 21.9–71.4) compared with 21.6% (95% CI, 11.1–38) in sleeve gastrectomy (p = 0.11). The pooled rate of 12-month EWL and BMI reduction after surgery was 66.1% (95% CI, 59.8–72.3%) and 13.7 kg/m2 (95% CI, 12.5–14.9), respectively. The pooled rate of decrease, increase, and no change of IBD medications were 45.6% (95% CI, 23.8–69.2), 11% (95% CI, 6.3–18.4), and 57.6% (95% CI, 39.2–74.1), respectively.

Conclusions

Bariatric surgery has acceptable safety and efficacy profile in IBD patients. Nearly half of patients had decrease in their IBD medications after bariatric surgery, and only 10% experienced therapeutic escalation following bariatric surgery. Sleeve gastrectomy may be the preferred procedure in this population.

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Abbreviations

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

CD:

Crohn’s disease

RYGB:

Roux-en-y gastric bypass

SG:

Sleeve gastrectomy

AGB:

Adjustable gastric banding

CI:

Confidence interval

PI:

Prediction interval

GRADE:

Grading of recommendations assessment, development and evaluation

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Acknowledgments

The authors thank medical librarian Loren Hackett, MLIS, AHIP for assisting us in literature search.

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Authors

Contributions

RG, BC: conception and design, drafting of article.

RG, BPM: study search, review, and selection.

RG, BPM: data collection and synthesis.

BPM, SP: statistical analysis of data and interpretation of results.

All authors: critical revision of the article for important intellectual content and final approval of the article.

Corresponding author

Correspondence to Rajat Garg.

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Conflict of Interest

MR has received research support from Abbvie, Janssen, Takeda, Pfizer Unrestricted Educational Grants from Abbvie, Janssen, UCB, Pfizer, Takeda, Salix, Shire Advisory Boards and Consultant for Abbvie, Janssen, UCB, Takeda, Pfizer, Miraca Labs, Amgen, Celgene, Seres, Allergan, Genentech, Gilead, Salix, and Prometheus.

BC is consultant for Takeda and TARGET PharmaSolutions along with speakers bureau for Takeda.

RG, BPM, SP, AA and AS has nothing to disclose.

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Appendix

Appendix

Table 4 MOOSE Checklist for Meta-analyses of Observational Studies

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Garg, R., Mohan, B.P., Ponnada, S. et al. Safety and Efficacy of Bariatric Surgery in Inflammatory Bowel Disease Patients: a Systematic Review and Meta-analysis. OBES SURG 30, 3872–3883 (2020). https://doi.org/10.1007/s11695-020-04729-4

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Keywords

  • IBD
  • Crohn’s disease
  • Obesity
  • Bariatric surgery
  • Ulcerative colitis
  • Inflammatory bowel disease