Bariatric Surgery and Crohn’s Disease

Author(s): Asnat Raziel, Refael Aminov, Nasser Sakran, David Goitein

Obesity is a chronic condition significantly associated with health disorders, including type-II diabetes, cardiovascular diseases and inflammation. Its prevalence has been on the rise for the last few decades, contributing to the World Health Organization’s statement touting obesity as the pandemic of the millennium. In parallel, its incidence in patients with inflammatory bowel disease (IBD) is rising, with the prevalence of obesity among patients with IBD is similar to that of the general population ~20%?30%. The main common pathophysiological pathways which might link obesity to IBD include: disproportional accumulation of visceral fat, impaired release of adipokines, chronic inflammation, and disturbances in the gut microbiome. Large retrospective studies have shown that obesity is associated with an increased risk of Crohn’s Disease (CD), a chronic, progressive, destructive condition whose incidence has been increasing as well (3-20 cases per 100,000). Bariatric surgery is a well-accepted, effective and safe option for significant and durable weight loss in individuals with morbidly obesity. Even though obesity is associated with higher rates of surgical complexities and postoperative complications (possibly further exacerbated in patients with IBD), data from case studies and multiple data analyses have demonstrated that bariatric surgery in patients with both morbid obesity and CD is safe and effective. Bariatric surgery infers marked improvement in weight-associated comorbidities, massive weight loss, as well as better quality of life, in this special patient population.