Bariatric Surgery and Risk of New-onset Inflammatory Bowel Disease: A Nationwide Cohort Study. (20th February 2021)

• Record Type: Journal Article
• Authors: Allin, Kristine H; Jacobsen, Rikke K; Ungaro, Ryan C; Colombel, Jean-Frederic; Egeberg, Alexander; Villumsen, Marie; Jess, Tine
• Is Part Of: Journal of Crohn's and colitis. Volume 15:Number 9(2021)
• Page Start: 1474
• Page End: 1480
• Publication Date: 2021-02-20
• Subjects: Colitis -- ulcerative -- Crohn's disease -- gastric bypass; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjab037
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aims: The aim of this study was to examine the risk of new-onset inflammatory bowel disease [IBD] following bariatric surgery. Methods: We conducted a nationwide population-based prospective cohort study of the entire Danish population 18 to 60 years of age, alive, and residing in Denmark, from 1996 to 2018. Bariatric surgery was included as a time-dependent variable, and Cox proportional hazards regression models were used to estimate hazard ratios [HRs] of IBD. We used a model adjusting for age, sex, and birth cohort and a multifactor-adjusted model additionally including educational status and number of obesity-related comorbidities. Results: We followed 3 917 843 individuals of whom 15 347 had a bariatric surgery, for development of new-onset IBD. During 106 420 person-years following bariatric surgery, 100 IBD events occurred [incidence rate 0.940/1000 person-years]. During 55 553 785 person-years without bariatric surgery, 35 294 events of IBD occurred [incidence rate 0.635/1000 person-years]. This corresponded to a multifactor-adjusted hazard ratio [HR] of 1.15 (95% confidence interval[CI], 0.94–1.40) for IBD. Multifactor-adjusted HRs of Crohn's disease [CD] and ulcerative colitis [UC] were 1.85 [95% CI, 1.40–2.44] and 0.81 [95% CI, 0.61–1.08], respectively. Among women, the multifactor-adjusted HR for CD was 2.18 [95% CI, 1.64–2.90]. When limiting the study population to individuals with a diagnosis of overweight/obesity, bariatric surgery remained associated with increased risk of CD, multifactor-adjusted HR 1.59 [95% CI, 1.18–2.13]. Conclusions: This nationwide cohort study shows that bariatric surgery is associated with increased risk of development of new-onset CD, but not of UC. The underlying mechanisms remain elusive.