Unraveling the Connection: Racial Influence on the Development of Ulcerative Colitis After Bariatric Surgery

Background: Bariatric surgery is an effective treatment for obesity and aids in enhancing metabolic health. However, it has been observed that there’s a heightened occurrence of Ulcerative Colitis (UC), especially following Roux-en-Y gastric bypass surgery. Despite these findings, the impact of race on the incidence of UC post-surgery has not been investigated. Given the prevalence of Ulcerative Colitis and its established connection to obesity, it is crucial to examine the effects of race. This study aims to ascertain whether racial differences influence the risk of developing Ulcerative Colitis in patients who have undergone bariatric surgery. Illuminating this relationship is key to improving patient outcomes and refining care following surgery. Methods: Our retrospective analysis reviewed patients who underwent bariatric surgery at our facility between 2009 and 2022. We collected data concerning comorbidities, insurance statuses, types of surgical procedures, colonoscopy, pathology reports, and baseline characteristics, employing ICD and CPT codes. We monitored patients who manifested Ulcerative colitis (UC) after surgery until 2023, categorizing them by gender, race, and the time elapsed. To balance baseline characteristics, we used propensity score matching. Patients with a history of UC before surgery were omitted from the study. We utilized Kaplan-Meier survival analysis and Cox proportional hazards models to determine the timing of UC onset across different racial groups. We applied odds ratios to discern independent factors impacting the study’s outcomes. Results: Between 2009 and 2022, our facility performed 960 bariatric surgeries. Of these procedures, 24 patients (or 0.02%) were diagnosed with UC, typically identified around 80±14.2 months post-surgery. The mean age of the participants was approximately 46±11.8 years, and females constituted 54.2% of the cohort. When examining racial breakdowns, 38.39% were African Americans, 24.4% were Whites, 21% were Asians, and 16.21% were Hispanics. Notably, Hispanic patients manifested UC within a considerably shorter duration than other racial groups (Breslow: 11.836, p=0.022). Additionally, a heightened risk of UC was observed among individuals from the lowest income bracket (OR: 3.15, P=0.041), emphasizing the influence of socioeconomic status on health outcomes. Discussion: This research contributes to bridging the knowledge deficit regarding the influence of race on the occurrence of UC following bariatric surgery. Our retrospective examination of 960 surgeries from 2009 to 2022 indicated a 0.02% incidence of UC, usually identified approximately 45 months after surgery. Importantly, Hispanic patients experienced the onset of UC in a notably shorter period compared to other racial groups, with those in lower income brackets encountering elevated risk levels. These observations highlight the critical role of racial and socioeconomic elements in refining care after surgery. Continued studies in this domain can facilitate the development of interventions to diminish these risks, thereby improving health outcomes for a broad spectrum of patient demographics.