Gero Daniel, Gutschow Christian A, Bueter Marco
Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
Inflamm Intest Dis. 2016 Oct;1(3):129-134. doi: 10.1159/000449267. Epub 2016 Sep 15.
The prevalence of morbid obesity and inflammatory bowel disease (IBD) is on the rise in association with a Western lifestyle. Both conditions are characterized by chronic inflammation. Bariatric surgery (BS) is a recommended and widely used approach to address severe obesity and its related comorbidities. Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) are the most frequently performed procedures worldwide. Evidence is scarce on outcomes of BS in IBD patients.
Systemic and adipose-tissue inflammation seems to decrease following BS. Different studies observed decreased serum levels of inflammatory markers (CRP, IL-6, MCP-1, and TNF-α) along with a reduction of insulin resistance both after RYGBP and SG. Several authors documented postbariatric improvement of concomitant chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus, gout, and psoriasis). There are only few retrospective case series on outcomes of BS in IBD patients. These studies reported safety and feasibility of BS and improvement in IBD status, manifested by prolonged disease remission and decreased use of pharmacotherapy. Weight loss outcomes were excellent and similar to those of non-IBD patients. The preferred surgical approach for morbidly obese IBD patients is SG in order to avoid potential drawbacks of RYGBP, such as malabsorption, intestinal manipulation, and augmentation of technical difficulties for future IBD surgery. Seven cases of newly diagnosed IBD after BS have been reported, which are more likely to result from postoperative intestinal microbial dysbiosis than from directly induced inflammation.
This review summarizes the outcomes of BS in IBD patients. SG is the preferable technique for morbidly obese IBD patients, who have potentially a double benefit from BS: weight loss and IBD remission. Further research is necessary to clarify the common pathophysiology of chronic inflammation in morbid obesity and in IBD. Postbariatric changes in gut microbiota should also be assessed to understand whether they promote IBD development or not.
随着西方生活方式的流行，病态肥胖和炎症性肠病（IBD）的患病率正在上升。这两种疾病均以慢性炎症为特征。减重手术（BS）是治疗重度肥胖及其相关合并症的一种推荐且广泛应用的方法。胃旁路术（RYGBP）和袖状胃切除术（SG）是全球最常施行的手术方式。关于IBD患者接受BS的结果的证据很少。
BS后全身和脂肪组织炎症似乎会减轻。不同研究观察到，RYGBP和SG后血清炎症标志物（CRP、IL-6、MCP-1和TNF-α）水平降低，同时胰岛素抵抗也有所减轻。几位作者记录了减重手术后伴发的慢性炎症性疾病（类风湿性关节炎、系统性红斑狼疮、痛风和银屑病）的改善情况。关于IBD患者接受BS的结果，仅有少数回顾性病例系列研究。这些研究报告了BS的安全性和可行性以及IBD状况的改善，表现为疾病缓解期延长和药物治疗使用减少。体重减轻效果良好，与非IBD患者相似。对于病态肥胖的IBD患者，首选的手术方式是SG，以避免RYGBP的潜在缺点，如吸收不良、肠道操作以及增加未来IBD手术的技术难度。已有7例BS后新诊断IBD的病例报告，这些病例更可能是由术后肠道微生物群失调引起，而非直接由炎症诱发。
本综述总结了IBD患者接受BS的结果。SG是病态肥胖IBD患者的首选技术，这类患者可能从BS中获得双重益处：体重减轻和IBD缓解。有必要进一步研究以阐明病态肥胖和IBD中慢性炎症的共同病理生理学。还应评估减重手术后肠道微生物群的变化，以了解它们是否促进IBD的发展。
