Risk of De-novo Inflammatory Bowel Disease Among Obese Patients Treated With Bariatric Surgery or Weight Loss Medications

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 Jr; Parambir S. Dulai

Disclosures

Aliment Pharmacol Ther. 2020;51(11):1067-1075. 

In This Article

Results

Prevalence of De-novo IBD

The three cohorts included 60 870 obese patients who were exposed to bariatric surgery, 193 790 obese patients who were exposed to weight loss medications and 5 021 210 who were obese for at least 2 years duration and without exposure to bariatric surgery or weight loss medications. De-novo IBD developed in 470 (n = 210 UC, n = 260 CD) of the bariatric surgery exposed patients (7.72 per 1000 patients; UC: 3.45 per 1000 patients, CD: 4.27 per 1000 patients), 1400 (n = 650 UC, n = 750 CD) of the weight loss medication exposed patients (7.22 per 1000 patients; UC: 3.35 per 1000 patients, CD: 3.87 per 1000 patients) and 58 530 (27 420 UC, n = 31 110 CD) of the obese controls (11.66 per 1000 patients; UC: 5.46 per 1000 patients, CD: 6.20 per 1000 patients, P < 0.0001).

IBD Patient Characteristics

The baseline demographics of the de novo UC and CD patients are described in Table 1 and Table 2. Compared with the obese control cohort, patients developing de-novo UC after bariatric surgery or exposure to weight loss medications were more likely to be middle aged, female gender and with concomitant type 2 diabetes mellitus. Compared with the obese control cohort, patients developing de-novo CD after bariatric surgery or exposure were more likely to have a history of rheumatoid arthritis and psoriasis. In contrast, patients on weight loss medications who developed de-novo CD were more likely to have hypertension, hyperlipidaemia and type 2 diabetes mellitus.

Risk of De-novo IBD After Bariatric Surgery

Prevalence estimates for de-novo CD and UC across different bariatric surgery exposures can be found in Table 3. Exposure to bariatric surgery was associated with a reduction in risk for development of de-novo UC compared with the obese control cohort, and this risk reduction was similar across all 3 types of bariatric surgery; Roux-en-Y gastrojejunostomy (prevalence OR, 0.63; 95% CI, 0.49–0.81), sleeve gastrectomy (OR, 0.61; 95% CI, 0.50–0.74) and gastric banding (OR, 0.69; 95% CI, 0.52–0.91). A reduction in risk for de-novo CD after exposure to bariatric surgery was only observed with sleeve gastrectomy (prevalence OR, 0.63; 95% CI, 0.53–0.75) and gastric banding (OR, 0.60; 95% CI, 0.46–0.80), and the association was not statistically significant for Roux-en-Y gastrojejunostomy (OR, 0.83; 95% CI, 0.68–1.03). Forest plots for the odds ratios can be found in Figure 1.

Figure 1.

Risk of de-novo ulcerative colitis (UC) and Crohn's disease (CD) after exposure to bariatric surgery vs obese controls. The figure represents prevalence odds ratio (OR) with 95% CI for risk of UC and CD after bariatric surgery compared with an obese control cohort without exposure to bariatric surgery or weight loss medications. All the values for OR are statistically significant except Roux-en-Y gastrojejunostomy (RYGB)/CD

Risk of De-novo IBD After Exposure to Weight Loss Medications

Prevalence estimates for de-novo CD and UC across different weight loss medication exposures can be found in Table 3. Exposure to bupropion/naltrexone (prevalence OR, 0.59; 95% CI, 0.46–0.74) or liraglutide (OR, 0.78; 95% CI, 0.7–0.86) was associated with a decreased risk of de-novo UC compared with the obese control cohort. No significant associations between exposure to orlistat (OR, 1.15; 95% CI, 0.89–1.48), phentermine (OR, 0.78; 95% CI, 0.62–1) or lorcaserin (OR, 0.88; 95% CI, 0.71–1.1) and the risk of de-novo UC were observed. Exposure to phentermine (OR, 0.77; 95% CI, 0.62–0.96), lorcaserin (OR, 0.76; 95% CI, 0.61–0.95), bupriopion/naltrexone (OR, 0.65; 95% CI, 0.53–0.8) or liraglutide (OR, 0.8; 95% CI, 0.72–0.88) was associated with a decreased risk of de-novo CD compared with the obese control cohort. No significant association between exposure to orlistat (OR, 0.99; 95% CI, 0.77–1.28) and the risk of de-novo CD was observed. Forest plots for the odds ratios can be found in Figure 2.

Figure 2.

Risk of de-novo ulcerative colitis (UC) and Crohn's disease (CD) after exposure to weight loss medications vs obese controls. The figure represents odds ratio (OR) with 95% CI for risk of UC and CD after weight loss medications (WLM). OR for every WLM are statistically significant for UC and CD except Orlistat

Weight Loss Medication vs Bariatric Surgery

Exposure to orlistat was associated with a 1.4-fold increased risk for de-novo UC compared with bariatric surgery (prevalence OR, 1.42; 95% CI, 1.06–1.89). Exposure to buproprion/naltrexone was associated with a reduced risk for de-novo UC (OR, 0.72; 95% CI, 0.55–0.95) and CD (OR, 0.75; 95% CI, 0.59–0.96) compared with bariatric surgery. Forest plots for other odds ratios with 95% CI can be found in Figure 3.

Figure 3.

Risk of de-novo ulcerative colitis (UC) and Crohn's disease (CD) after exposure to bariatric surgery vs weight loss medications (WLM). The figure represents odds ratio (OR) with 95% CI for risk of UC and CD after WLM compared with bariatric surgery as control population

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