Swanson Sophia M, Harper Jason, Zisman Timothy L
University of Washington Medical Center.
Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Curr Opin Gastroenterol. 2018 Mar;34(2):112-119. doi: 10.1097/MOG.0000000000000422.
The review summarizes our current understanding of how obesity impacts diagnostic studies and therapies used in inflammatory bowel disease (IBD) as well as the safety and efficacy of medical and surgical weight loss therapies in the obese IBD patient.
Many of the diagnostic tools we rely on in the identification and monitoring of IBD can be altered by obesity. Obesity is associated with increased acute phase proteins and fecal calprotectin. It can be more difficult to obtain and interpret cross sectional imaging of obese patients. Recent studies have also shown that common therapies used to treat IBD may be less effective in the obese population and may impact comorbid disease. Our understanding of how best to measure obesity is evolving. In addition to BMI, studies now include measures of visceral adiposity and subcutaneous to visceral adiposity ratios. An emerging area of interest is the safety and efficacy of obesity treatment including bariatric surgery in patients with IBD. A remaining question is how weight loss may alter the course of IBD.
The proportion of obese IBD patients is on the rise. Caring for this population requires a better understanding of how obesity impacts diagnostic testing and therapeutic strategies. The approach to weight loss in this population is complex and future studies are needed to determine the safety of medical or surgical weight loss and its impact on the course of disease.
本综述总结了我们目前对肥胖如何影响炎症性肠病（IBD）诊断研究和治疗，以及肥胖IBD患者体重减轻的药物和手术治疗的安全性和有效性的理解。
我们在IBD识别和监测中依赖的许多诊断工具可能会因肥胖而改变。肥胖与急性期蛋白和粪便钙卫蛋白增加有关。获取和解读肥胖患者的横断面影像可能会更加困难。最近的研究还表明，用于治疗IBD的常用疗法在肥胖人群中可能效果较差，并且可能影响合并症。我们对如何最佳测量肥胖的理解正在不断发展。除了体重指数（BMI）外，现在的研究还包括内脏脂肪测量以及皮下与内脏脂肪比例。一个新兴的研究领域是肥胖治疗（包括IBD患者的减重手术）的安全性和有效性。一个悬而未决的问题是体重减轻如何改变IBD的病程。
肥胖IBD患者的比例正在上升。照顾这一人群需要更好地理解肥胖如何影响诊断测试和治疗策略。这一人群的体重减轻方法很复杂，需要未来的研究来确定药物或手术减重的安全性及其对疾病病程的影响。
