Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL.
J Clin Gastroenterol. 2024;58(5):447-453. doi: 10.1097/MCG.0000000000001879. Epub 2023 Jun 27.
A growing body of evidence suggests a negative impact of obesity on the disease activity of inflammatory bowel disease (IBD). The primary aim of the study was to evaluate disease outcomes of IBD in patients after bariatric surgery (BS).
Patients with IBD and morbid obesity who underwent BS were compared with patients with IBD and morbid obesity without BS in a retrospective, propensity-score matched cohort study using TriNetX, a multi-institutional database. The primary aim was to assess the 2-year risk of a composite of disease-related complications, which included intravenous steroid use or IBD-related surgery. Risk was expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
In all, 482 patients (3.4%) with IBD and morbid obesity underwent BS (mean age 46.9±11.2 y old, mean BMI 42.1±7.72 kg/m 2 , Crohn's disease 60%). After propensity-score matching, the BS cohort had a lower risk (aOR 0.31, 95% CI 0.17-0.56) of a composite of IBD-related complications compared with the control cohort. After propensity-score matching, the BS cohort with sleeve gastrectomy had a decreased risk (aOR 0.45, 95% CI 0.31-0.66) of a composite of IBD-related complications. There was no difference in the risk (aOR 0.77, 95% CI 0.45-1.31) of a composite of IBD-related complications between the BS cohort with Roux-en-Y gastric bypass (RYGB) compared with the control cohort.
Sleeve gastrectomy but not Roux-en-Y gastric bypass is associated with improved disease-specific outcomes in patients with IBD and morbid obesity.
越来越多的证据表明肥胖对炎症性肠病（IBD）的疾病活动有负面影响。本研究的主要目的是评估肥胖症患者接受减肥手术后（BS）的 IBD 疾病结局。
使用 TriNetX（一个多机构数据库）进行回顾性倾向评分匹配队列研究，比较肥胖症合并 IBD 且接受 BS 治疗的患者与肥胖症合并 IBD 但未接受 BS 治疗的患者。主要目的是评估疾病相关并发症的复合终点（包括静脉内类固醇使用或 IBD 相关手术）的 2 年风险。风险表示为调整后的优势比（aOR）和 95%置信区间（CI）。
共有 482 名肥胖症合并 IBD 的患者（3.4%）接受了 BS（平均年龄 46.9±11.2 岁，平均 BMI 42.1±7.72kg/m 2 ，克罗恩病 60%）。在进行倾向评分匹配后，BS 组发生 IBD 相关并发症的复合终点的风险较低（aOR 0.31，95% CI 0.17-0.56）。与对照组相比，BS 组中的袖状胃切除术组发生 IBD 相关并发症的复合终点的风险降低（aOR 0.45，95% CI 0.31-0.66）。BS 组中的 Roux-en-Y 胃旁路术（RYGB）与对照组相比，发生 IBD 相关并发症的复合终点的风险无差异（aOR 0.77，95% CI 0.45-1.31）。
与 Roux-en-Y 胃旁路术相比，袖状胃切除术与肥胖症合并 IBD 患者的疾病特异性结局改善相关。
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