Inflammatory Bowel Disease (IBD) is used to describe various disorders that involve chronic inflammation of the body’s digestive tract. IBD is classified into two type’s Ulcerative colitis and Crohn’s disease. This article discusses the relation of bariatric surgery with increased risk of new-onset inflammatory disease.

Ulcerative colitis causes long-established inflammation and ulcers (sores) in the inner part of the large intestine and also rectum. The second one, Crohn’s disease causes inflammation in the digestive tract and it frequently affects the tissues deeply. Both these types often show signs like pain in the abdomen, diarrhea, weight loss and fatigue. Inflammatory Bowel Disease can be very exhausting for an individual. This disease can also bring life-threatening complications in a person suffering from it.

Is There a Link Between Bariatric Surgery & Increased Risk of New-onset IBD

Bariatric surgery is performed on people who have obesity. The size of the stomach is reduced with the help of a gastric band or a portion of the stomach is removed for achieving weight loss. Rerouting the small intestine to the small pouch is also the solution for weight loss.

It is an increasing concern if bariatric surgery is associated with an increased risk of new-onset inflammatory bowel disease. Studies suggest that new-onset inflammatory bowel disease is associated with a history of bariatric surgery.¹

It is seen that people who have inflammatory bowel disease after getting bariatric surgery need to be hospitalized. Patients also suffer from a bowel obstruction and vitamin deficiency is also common. Patients with Crohn’s disease are at greater risk of complications after bariatric surgery than a patient with ulcerative colitis. Nevertheless, whichever method of bariatric surgery is selected, it can affect the part of the intestine where the disease is located in patients with Crohn’s disease.

Some of the following complications that may arise in people with laparoscopic Roux-en-Y gastric bypass are anastomotic strictures, the formation of fistulas and ileus. Bariatric surgery may increase the malabsorption and risk of cancer in the small intestine, as inflammation and formation of blind passages in the small intestine. The surgery can also trigger diarrhea in some people. A recent analysis showed an association between Roux-en-Y gastric bypass (RYGBP) and an increased risk of kidney stones, contrarily to other bariatric surgery procedures like gastric banding which may help to decrease kidney stones risk. Some other problems that arise after any type of bariatric surgery include pneumonia, recurring aspiration, dumping syndrome and ketoacidosis. Symptomatic cholelithiasis is a rare condition that might also pose a problem after the operation.

Some of the common complications that may be more persistent are bowel obstruction and stricture, anastomotic leak and abscess. Protein malnutrition is a recurring complication after biliopancreatic diversion as compared to Roux-en-Y gastric bypass or sleeve gastrectomy. Hence biliopancreatic diversion is less commonly practiced in bariatric surgery centers. It is also not recommended in inflammatory bowel disease patients who already have a high risk of malabsorption. These problems too add to the possibility of bariatric surgery being associated with an increased risk of new-onset inflammatory disease.

Surgically induced malabsorption and surgery of the abdomen, which also includes intestinal manipulation adversely impact inflammatory bowel disease patients. The operation worsens diarrhea or it also increases abdominal pain than ever before in patients who have a history of bariatric surgery. The reasons for the increased risk for inflammatory bowel disease may be because of changes that take place in the microbiome although that is hypothetical and also needs to be proven in outlook studies in patients who underwent bariatric surgery.

Some studies have also concluded that the increased risk of IBD is unclear but alterations in the microbiome after bariatric surgery is a possibility. Considering this, further research is needed to confirm the association of bariatric surgery with an increased risk of new-onset inflammatory bowel disease.²

Causes of Inflammatory Bowel Disease

The exact reason as to why inflammatory bowel disease occurs is still unknown. Earlier researchers thought that diet and stress can be the cause but today some experts believe that those are not the cause of IBD but they may aggravate it. Immune system malfunction can be the cause of IBD. When an individual’s immune system fights against the bacteria or virus, abnormal immune tries to retaliate. This causes the immune system to strike cells present in the digestive tract. Heredity plays an important role in the disease. People whose family members have already been affected by the disease are also likely to get inflammatory bowel disease. However, this might not always happen. People whose family doesn’t have this disease history also get affected by it.

Symptoms of Inflammatory Bowel Disease

Symptoms of inflammatory bowel disease may differ from person to person as it depends on the severity and also the place where it has occurred. The symptoms of the disease may start from mild and can reach up to severe. The patients are likely to experience zestful illness along with sessions of remission. A few common signs and symptoms that are found in both Crohn’s disease, as well as ulcerative colitis, are a loss of appetite, unintentional weight loss, pain and cramping in the abdomen, blood in the stool, diarrhea, fatigue, and fever.

Complications of Inflammatory Bowel Disease

While bariatric surgery is associated with increased risk of new-onset inflammatory bowel disease, it is important to understand the complications IBD. of Some common complications found in both ulcerative colitis and Crohn’s disease. Some of them are mentioned below.

Colon cancer is one complication in which a patient suffering from inflammatory bowel disease is at high risk.
Second is skin, eye and joint complication in which patients might suffer from various disorders like skin lesions, eye inflammation, and arthritis.
The third is the blood clot formation. Inflammatory bowel disease might increase the number of blood clots in veins and arteries.
The fourth complication is medication side effects. Certain medicines provided by the doctor for the treatment of inflammatory bowel disease are found in contributing to the cause of cancer.
Last but not least complication is primary sclerosing cholangitis. It is a condition caused when the inflammation produces scars within the bile ducts. Slowly it damages the liver.
Complications of Crohn’s disease may include bowel obstruction, anal fissure, ulcers, fistulas, and malnutrition. Ulcerative colitis can give rise to complications like extreme dehydration, toxic megacolon, and perforated colon.

Ways to Prevent Inflammatory Bowel Disease

Changing diet can help a person to prevent inflammatory bowel disease. Any particular food is not the cause of inflammatory bowel disease. Doctors do not tell the patient what to eat and what to not. However, few foods might aggravate the signs and symptoms of a person. If a person finds that certain food worsens the symptoms of inflammatory bowel disease, then it is best to try to eliminate it. Many people find that reducing the intake of dairy products from the diet can help one prevent inflammatory bowel disease. A person can be lactose intolerant, which means they can have difficulty digesting milk sugar in dairy foods. A person suffering from Crohn’s disease is not able to digest or absorb fat as well. This fat passes intestine making diarrhea wore in that person. Foods like butter, cream, fried food, and margarine should be avoided.

People suffering from inflammatory bowel disease should watch out for fiber intake in them. Food containing high fiber contributes to making inflammatory bowel disease worse. So people should cut the intake of high fiber food. Smoking increases the chance of getting affected by Crohn’s disease and ulcerative colitis. It overall damages the health of a person. It is advisable to quit smoking as it can improve the digestive tract of a person.

Prognosis of Inflammatory Bowel Disease

The mortality in Crohn’s disease is higher than expected, especially in males. However, overall mortality has declined than before and currently is 5% or lesser.

Proctocolectomy and ileostomy can help to cure Crohn’s disease. Crohn’s disease can relapse even after the help of proctocolectomy and ileostomy and its chance are almost 20% to 35%.³ In ulcerative colitis the more the colon is involved the greater are the complications. The anatomic patterns determine the extent of complications in Crohn’s disease. Children and adolescents are more seriously affected by inflammatory bowel disease. Patients who suffer from either Crohn’s disease or ulcerative colitis have chances of developing cancer. People successfully fight with inflammatory bowel disease and recover easily and quickly with the help of medical treatment and their optimism.

Conclusion

Inflammatory bowel disease may prove to be life-threatening in some cases if the treatment is not received at an early stage. Some studies have shown that bariatric surgery is associated with an increased risk of new-onset inflammatory disease. Bariatric surgery may have many side effects but also have much potential to treat its patients. Studies are going on to know as to how to treat these adverse effects that the patients of inflammatory bowel disease suffer after bariatric surgery.

References

Also Read:

Bariatric Surgery: Indications, Patient Selection, Current Surgical Options, Possible Complications

Is There a Link Between Bariatric Surgery & Increased Risk of New-onset IBD