Skip to main content
SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

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

References

  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang XR, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. Lancet 2014;384:766–81.

  2. Smith KB, Smith MS. Obesity statistics. Prim Care. 2016;43:121–35. ix

    Article  PubMed  Google Scholar 

  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 e30.

  4. Shivashankar R, Tremaine WJ, Harmsen WS, et al. Incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted county, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–63.

    Article  PubMed  Google Scholar 

  5. Singh S, Dulai PS, Zarrinpar A, et al. Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes. Nat Rev Gastroenterol Hepatol. 2017;14:110–21.

    Article  CAS  PubMed  Google Scholar 

  6. Gustavsson S, Ilstrup DM, Morrison P, et al. Roux-Y stasis syndrome after gastrectomy. Am J Surg. 1988;155:490–4.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zwintscher NP, Horton JD, Steele SR. Obesity has minimal impact on clinical outcomes in children with inflammatory bowel disease. J Pediatr Surg. 2014;49:265–8. discussion 8

    Article  PubMed  Google Scholar 

  11. Eliasson B, Liakopoulos V, Franzen S, et al. Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study. Lancet Diabetes Endocrinol. 2015;3:847–54.

    Article  PubMed  Google Scholar 

  12. Duvoisin C, Favre L, Allemann P, et al. Roux-en-Y gastric bypass: ten-year results in a cohort of 658 patients. Ann Surg. 2018;268:1019–25.

    Article  PubMed  Google Scholar 

  13. Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bazerbachi F, Vargas Valls EJ, Abu Dayyeh BK. Recent clinical results of endoscopic bariatric therapies as an obesity intervention. Clin Endosc. 2017;50:42–50.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Committee SG. SAGES guideline for clinical application of laparoscopic bariatric surgery. Surg Obes Relat Dis. 2009;5:387–405.

    Article  Google Scholar 

  16. Subramanian V, Saxena S, Kang JY, et al. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008;103:2373–81.

    Article  PubMed  Google Scholar 

  17. Beddy D, Dozois EJ, Pemberton JH. Perioperative complications in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1610–9.

    Article  PubMed  Google Scholar 

  18. Hwang C, Ross V, Mahadevan U. Micronutrient deficiencies in inflammatory bowel disease: from a to zinc. Inflamm Bowel Dis. 2012;18:1961–81.

    Article  PubMed  Google Scholar 

  19. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–7.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. Ann Intern Med. 2009;151:264–9.

    Article  PubMed  Google Scholar 

  22. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. Jama. 2000;283:2008–12.

    Article  CAS  PubMed  Google Scholar 

  23. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  24. Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.

    Article  PubMed  Google Scholar 

  25. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  26. Sutton AJ, Abrams KR, Jones DR, et al. Methods for meta-analysis in medical research. John Wiley & Sons Ltd New York. 2000;2000:205–28.

    Google Scholar 

  27. Higgins J, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. Journal of the Royal Statistical Society: Series A (Statistics in Society) 2009;172:137–159.

  28. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. Bmj. 2011;342:d549.

    Article  PubMed  Google Scholar 

  29. Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc. 2019;89:902–3.

    Article  PubMed  Google Scholar 

  30. Kanwal F, White D. “Systematic reviews and meta-analyses ” in <em> clinical gastroenterology and hepatology </em>. Clinical Gastroenterology and Hepatology;10:1184–6.

  31. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal 2003;327:557, 560.

  32. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. Journal of Clinical Epidemiology;64:1294–302.

  33. Easterbrook PJ, Gopalan R, Berlin JA, Matthews DR. Publication bias in clinical research. The Lancet;337:867–72.

  34. Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication Bias in meta-analysis. Biometrics. 2000;56:455–63.

    Article  CAS  PubMed  Google Scholar 

  35. Rothstein HR, Sutton AJ, Borenstein M. Publication bias in meta-analysis: prevention, assessment and adjustments: John Wiley & Sons; 2006.

    Google Scholar 

  36. Aelfers S, Janssen IMC, Aarts EO, et al. Inflammatory bowel disease is not a contraindication for bariatric surgery. Obes Surg. 2018;28:1681–7.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. Fausel R, Ramos LMR, Ungaro RC, et al. Sa1931 the impact of bariatric surgery on the course of inflammatory bowel disease. Gastroenterology. 2016;150:S407.

    Article  Google Scholar 

  40. Han SM, Moon R, Park SS, et al. Laparascopic sleeve gastrectomy in morbd obesity patients with inflammatory bowel disease. 2013.

    Google Scholar 

  41. Heshmati K, Lo T, Tavakkoli A, et al. Short-term outcomes of inflammatory bowel disease after roux-en-Y gastric bypass vs sleeve gastrectomy. J Am Coll Surg. 2019;228:893–901. e1

    Article  PubMed  Google Scholar 

  42. Hudson JL, Barnes EL, Herfarth HH, et al. Bariatric surgery is a safe and effective option for patients with inflammatory bowel diseases: a case series and systematic review of the literature. Inflamm Intest Dis. 2019;3:173–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

  44. McKenna NP, Habermann EB, Sada A, Kellogg TA, McKenzie TJ. 66 – is bariatric surgery safe and effective in patients with inflammatory bowel disease? a Multi-Institutional Experience. Gastroenterology 2019;156:S-1375-S-6.

  45. Ungar B, Kopylov U, Goitein D, et al. Severe and morbid obesity in Crohn’s disease patients: prevalence and disease associations. Digestion. 2013;88:26–32.

    Article  PubMed  Google Scholar 

  46. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014:CD003641.

  48. Bazerbachi F, Sawas T, Vargas EJ, et al. Bariatric surgery is acceptably safe in obese inflammatory bowel disease patients: analysis of the nationwide inpatient sample. Obes Surg. 2018;28:1007–14.

    Article  PubMed  Google Scholar 

  49. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.

    Article  PubMed  Google Scholar 

  50. Garb J, Welch G, Zagarins S, et al. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009;19:1447–55.

    Article  PubMed  Google Scholar 

  51. Sharma P, McCarty TR, Njei B. Impact of bariatric surgery on outcomes of patients with inflammatory bowel disease: a nationwide inpatient sample analysis, 2004-2014. Obes Surg. 2018;28:1015–24.

    Article  PubMed  Google Scholar 

  52. Greco A, Caviglia GP, Brignolo P, et al. Glucose breath test and Crohn’s disease: diagnosis of small intestinal bacterial overgrowth and evaluation of therapeutic response. Scand J Gastroenterol. 2015;50:1376–81.

    Article  CAS  PubMed  Google Scholar 

  53. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13:1198–204.

    Article  PubMed  Google Scholar 

  54. Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr. 2006;83:461S–5S.

    Article  CAS  PubMed  Google Scholar 

  55. Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J Clin Invest. 2011;121:2111–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Blain A, Cattan S, Beaugerie L, et al. Crohn’s disease clinical course and severity in obese patients. Clin Nutr. 2002;21:51–7.

    Article  CAS  PubMed  Google Scholar 

  57. 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.

    Article  PubMed  Google Scholar 

  58. Bertin B, Desreumaux P, Dubuquoy L. Obesity, visceral fat and Crohn’s disease. Curr Opin Clin Nutr Metab Care. 2010;13:574–80.

    Article  CAS  PubMed  Google Scholar 

  59. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157:121–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Cani PD, Osto M, Geurts L, et al. Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obesity. Gut Microbes. 2012;3:279–88.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Schirmer M, Smeekens SP, Vlamakis H, et al. Linking the human gut microbiome to inflammatory cytokine production capacity. Cell. 2016;167:1897.

    Article  CAS  PubMed  Google Scholar 

  62. Desreumaux P, Ernst O, Geboes K, et al. Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease. Gastroenterology. 1999;117:73–81.

    Article  CAS  PubMed  Google Scholar 

  63. Drouet M, Dubuquoy L, Desreumaux P, et al. Visceral fat and gut inflammation. Nutrition. 2012;28:113–7.

    Article  CAS  PubMed  Google Scholar 

  64. Sheehan AL, Warren BF, Gear MW, et al. Fat-wrapping in Crohn’s disease: pathological basis and relevance to surgical practice. Br J Surg. 1992;79:955–8.

    Article  CAS  PubMed  Google Scholar 

  65. Mao R, Kurada S, Gordon IO, et al. The mesenteric fat and intestinal muscle interface: creeping fat influencing stricture formation in Crohn’s disease. Inflamm Bowel Dis. 2019;25:421–6.

    Article  PubMed  Google Scholar 

  66. Boutros M, Maron D. Inflammatory bowel disease in the obese patient. Clin Colon Rectal Surg. 2011;24:244–52.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Furet JP, Kong LC, Tap J, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with metabolic and low-grade inflammation markers. Diabetes. 2010;59:3049–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Guinane CM, Cotter PD. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Ther Adv Gastroenterol. 2013;6:295–308.

    Article  Google Scholar 

  69. Tremaroli V, Karlsson F, Werling M, et al. Roux-en-Y gastric bypass and vertical banded gastroplasty induce long-term changes on the human gut microbiome contributing to fat mass regulation. Cell Metab. 2015;22:228–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Rajat Garg

  2. Department of Internal Medicine, Banner University Medical Center/University of Arizona, Tucson, AZ, USA

    Babu P. Mohan

  3. Department of Internal Medicine, Carilion Roanoke Medical Center, Roanoke, VA, USA

    Suresh Ponnada

  4. Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA

    Amandeep Singh, Miguel Regueiro & Benjamin Click

  5. Department of Laparoscopic and Bariatric Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Ali Aminian

Authors
  1. Rajat Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Babu P. Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suresh Ponnada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amandeep Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Aminian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miguel Regueiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benjamin Click
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Ethics declarations

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.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent does not apply.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Appendix

Appendix

Table 4 MOOSE Checklist for Meta-analyses of Observational Studies
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04729-4

Keywords

Search

Navigation