Lindsey M Freeman1, Andrew T Strong2, Gautam Sharma2, Suriya Punchai2, John H Rodriguez2, Donald F Kirby3,4, Matthew Kroh2,4,5. 1. Case Western Reserve School of Medicine, Case Western Reserve University, 2109 Adelbert Road, Cleveland, OH, 44106, USA. lxf148@case.edu. 2. Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA. 3. Center for Human Nutrition, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA. 4. Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. 5. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Abstract
INTRODUCTION: Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well studied in the setting of pre-existing celiac disease. MATERIALS AND METHODS: Patients who underwent Roux-en-Y gastric bypass (RYGB) from January 2002 to December 2015 were retrospectively reviewed for either diagnosis of or serum testing for celiac disease. Identified patients were re-reviewed for adherence to American Gastroenterological Association (AGA) diagnostic criteria. Patient demographics, operative data, and post-operative weight loss and nutritional parameters were collected. RESULTS: Of the > 12,000 patients who underwent bariatric surgery during this study period, there were 342 patients that had abnormal serology or pathology results. Expert review confirmed three patients (0.8%) with celiac disease diagnosed before RYGB procedure. All were female, with an average age of 33 years and a mean BMI of 44.07 kg/m2. At the time of surgery, two of the three patients were following a gluten-free diet. At 6 months follow-up, mean % excess weight loss was 76.5%. The patients following a gluten-free diet preoperatively continued post-operatively. No patients were anemic nor had vitamin B12 or iron deficiencies at 12-month follow-up. Two patients had vitamin D insufficiencies and responded to daily oral supplementation. CONCLUSION: Though many bariatric patients may carry a presumptive diagnosis of celiac disease, a small percentage of these meet AGA diagnostic criteria. RYGB appears safe in this population with comparable weight loss in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.
INTRODUCTION: Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well studied in the setting of pre-existing celiac disease. MATERIALS AND METHODS:Patients who underwent Roux-en-Y gastric bypass (RYGB) from January 2002 to December 2015 were retrospectively reviewed for either diagnosis of or serum testing for celiac disease. Identified patients were re-reviewed for adherence to American Gastroenterological Association (AGA) diagnostic criteria. Patient demographics, operative data, and post-operative weight loss and nutritional parameters were collected. RESULTS: Of the > 12,000 patients who underwent bariatric surgery during this study period, there were 342 patients that had abnormal serology or pathology results. Expert review confirmed three patients (0.8%) with celiac disease diagnosed before RYGB procedure. All were female, with an average age of 33 years and a mean BMI of 44.07 kg/m2. At the time of surgery, two of the three patients were following a gluten-free diet. At 6 months follow-up, mean % excess weight loss was 76.5%. The patients following a gluten-free diet preoperatively continued post-operatively. No patients were anemic nor had vitamin B12 or iron deficiencies at 12-month follow-up. Two patients had vitamin Dinsufficiencies and responded to daily oral supplementation. CONCLUSION: Though many bariatric patients may carry a presumptive diagnosis of celiac disease, a small percentage of these meet AGA diagnostic criteria. RYGB appears safe in this population with comparable weight loss in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.
Authors: David S Sanders; Andrew D Hopper; Iman A F Azmy; Nahida Rahman; David P Hurlstone; John S Leeds; Rina R George; Neeraj Bhala Journal: Ann Surg Date: 2005-08 Impact factor: 12.969
Authors: B Admou; L Essaadouni; K Krati; K Zaher; M Sbihi; L Chabaa; B Belaabidia; A Alaoui-Yazidi Journal: Gastroenterol Res Pract Date: 2012-07-03 Impact factor: 2.260