Lindsey Freeman1, Andrew T Strong, MD1, Gautam Sharma, MD1, Suriya Punchai, MD1, John H Rodriguez, MD1, Donald Kirby, MD2, Matthew Kroh, MD1. 1Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic, 2Dept. of Gastroenterology, Cleveland Clinic
Introduction: Bariatric surgery is generally safe and effective, but co-existing malabsorptive processes may further increase the risk of complications or nutritional deficiencies. Bariatric surgery has not been well-studied in the setting of pre-existing celiac disease. Some literature would suggest a gluten free diet may contribute to weight gain pre-operatively and/or may impair post-operative weight loss. Here described is the only reported series of patients with celiac disease undergoing bariatric surgery.
Methods: Patients who underwent bariatric surgery from January 2002 to December 2015 were retrospectively reviewed. Patients with a recorded diagnosis of celiac disease or testing for suspicion of celiac disease were identified and then re-reviewed by a gastroenterologist with expertise in celiac disease to confirm that serum testing, pathology, and/or resolution following a gluten free diet were accurate and diagnostic according to American Gastroenterological Association (AGA) criteria. Patient demographics, operative data, and follow-up with special attention to weight loss and nutritional parameters were collected.
Results: During this time period, greater than 12,000 patients underwent bariatric surgery. There were 68 patients that were identified as having abnormal results in serology or pathology. Expert review confirmed 4 patients with celiac disease based on AGA criteria. All patients were female, with an average age of 43 years, and a mean BMI of 42.7 kg/m2. Weight-related co-morbidities included: pre-diabetes or diabetes (3), hyperlipidemia (2) and sleep apnea (2). At the time of surgery 3 out of the 4 patients were following a gluten free diet. Three patients underwent laparoscopic gastric bypass, and one patient underwent a laparoscopic sleeve gastrectomy. There were no perioperative complications.
At 6 months follow-up, the average percent excess weight loss was 66.2%. The same patients that were following a gluten free diet preoperatively continued postoperatively as well. No patients were anemic, or had vitamin B12 or iron deficiencies at 6-month follow-up. One patient had vitamin D deficiency and responded to daily oral supplementation at a standard post-operative dose. Intermediate term follow up greater than 2 years was available for 2 patients revealing new vitamin D deficiency, treated with daily oral supplementation.
Conclusions: Though many bariatric patients may present with a presumptive diagnosis of celiac disease, a small percentage of these meet criteria set forth by the AGA. In this series, bariatric surgery appeared safe and effective. Weight loss was comparable to reported rates in non-celiac counterparts. Increased attention to vitamin D levels may be warranted post-operatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79686
Program Number: P551
Presentation Session: Poster (Non CME)
Presentation Type: Poster
