Risk of de‐novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

• DOI: 10.1111/apt.15721
• Publication Date: 2020-04-22T03:20:15Z
• Authors: Gursimran S. Kochhar; Aakash Desai; Aslam Syed; Abhinav Grover; Sandra El Hachem; Heitham Abdul‐Baki; Preethi Chintamaneni; Elie Aoun; Sowjanya Kanna; Dalbir S. Sandhu; Siddharth Singh; Bo Shen; Edward V. Loftus; Parambir S. Dulai
• Keywords: Adult; Aged, 80 and over; Male; 2. Zero hunger; Adolescent; Bariatric Surgery; Middle Aged; Inflammatory Bowel Diseases; Risk Assessment; Obesity, Morbid; 3. Good health; Cohort Studies; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Weight Loss; Prevalence; Humans; Female; Anti-Obesity Agents; Aged; Retrospective Studies

SummaryBackgroundAn association between bariatric surgery and development of de‐novo inflammatory bowel disease (IBD) has been observed.AimTo evaluate further the association among bariatric surgery, weight loss medications, obesity and new‐onset IBD.MethodsUsing Explorys, a population‐based Health Insurance Portability and Accountability Act compliant database, we estimated the prevalence of de‐novo IBD among patients treated with bariatric surgery (Roux‐en‐Y gastrojejunostomy, laparoscopic sleeve gastrectomy or gastric banding) (n = 60 870) or weight loss medications (orlistat, phentermine/topiramate, lorcaserin, bupropion/naltrexone and liraglutide) (n = 193 790) compared with obese controls (n = 5 021 210), between 1999 and 2018.ResultsThe prevalence of de‐novo IBD was lower among obese patients exposed to bariatric surgery (7.72 per 1000 patients) or weight loss medications (7.22 per 1000 patients) compared with patients with persistent obesity not exposed to these interventions (11.66 per 1000 patients, P < 0.0001). The risk reduction for de‐novo IBD was consistent across bariatric surgeries and weight loss medications with the exception of orlistat which was not associated with a reduction in risk for de‐novo IBD compared with the persistent obese control cohort.ConclusionObese patients undergoing treatment with bariatric surgery or weight loss medications are at a lower risk for developing de‐novo IBD compared with persistently obese controls not exposed to these interventions. These data suggest that obesity and ineffective management of obesity are risk factors for de‐novo IBD. Further research is needed to confirm these observations and understand potential mechanisms.