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The Impact of Metabolic Bariatric Surgery on Inflammatory Bowel Disease Risk and Outcomes in Adults With Obesity: a
Antoinette Pusateri1, Yevgeniya Gokun2, Kenneth Allen3
1Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, United States. antoinette.pusateri@osumc.edu.
Introduction:
The risk of de novo inflammatory bowel disease (IBD) after metabolic bariatric surgery (MBS) has been described, but the timing and severity of de novo IBD is unclear.
Methods:
Using MarketScan Databases, patients with severe obesity undergoing Roux-en-Y-gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) were propensity-matched with patients with severe obesity without MBS (controls). Adjusted hazard ratio (aHR) assessed ulcerative colitis (UC) or Crohn's disease (CD) hazard <3 or ≥3 years from surgery or severe obesity. IBD severity was assessed using healthcare utilization-based proxies including medication exposure, IBD-related hospitalizations, and surgical interventions.
Results:
The cohort included 100,832 adults with MBS versus 376,855 controls (76.0% females, median age of 44 years). The incidence of IBD was higher in MBS cohort versus controls (61.2 vs. 44.4 per 100,000 adults/year). Within 3 years, patients with MBS had a 24% lower risk of de novo IBD versus controls (aHR: 0.76, 95% CI: 0.60-0.95). When stratified by surgery and IBD type, VSG had reduction in CD risk (aHR=0.46, 95% CI:0.22-0.96), while RYGB had reduction in UC risk (aHR=0.22, 95% CI:0.06-0.75). After 3 years, patients with MBS, particularly VSG, had greater than 2-fold increased risk of IBD (aHR=2.28, 95%CI: 1.02-5.06). Markers of treatment intensity and healthcare utilization did not significantly differ between groups overall; however, a higher proportion of UC patients in the MBS cohort underwent colectomy, though absolute event numbers were small. (8.70% vs 1.57%, p=0.03).
Conclusion:
While MBS may lower IBD risk initially, IBD risk increases after 3 years, especially UC after VSG, and may be more severe as indicated by the higher proportion of colectomies for patients in the MBS cohort versus controls. Findings regarding treatment intensity should be interpreted cautiously, as objective measures of disease activity were not available in claims data.
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