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From Surgery to Symptomatology: Race’s Role in Crohn’s Disease Emergence Post-Bariatric Surgery
AIBD 2023
Background:
Bariatric surgery is a potent remedy for obesity, fostering improved metabolic health. Nonetheless, notable evidence points towards increased Crohn’s disease, predominantly after Sleeve gastrectomy procedures. The influence of race on the incidence of Crohn’s disease post-surgery remains unexplored to date. Considering the prevalent nature of Crohn’s disease and its affirmed linkage to bariatric surgery, exploring the impact of racial differences is imperative. This study aims to determine if racial disparities play a role in influencing the likelihood of developing Crohn’s disease in an individual’s post-bariatric surgery. Unveiling this correlation is essential for enhancing patient outcomes and fine-tuning postoperative care.
Methods:
We conducted a retrospective study analyzing patients who received bariatric surgery at our institution from 2009 to 2022. Information about comorbidities, insurance statuses, surgical methods, colonoscopy and pathology reports, and initial patient characteristics was gathered using ICD and CPT codes. Patients developing Crohn’s disease post-surgery were observed until 2023 and were classified based on gender, race, and time since surgery. Propensity score matching was utilized to equate baseline characteristics. Individuals with a prior history of Crohn’s disease were excluded from the research. Kaplan-Meier survival analysis and Cox proportional hazards models were employed to study the onset of Crohn’s across varying racial groups. Furthermore, odds ratios were utilized to identify independent variables affecting the outcomes of our study.
Results:
From 2009 to 2022, our institution conducted 960 bariatric surgeries. Among these, 36 patients, representing 0.03%, were identified with Crohn’s, generally diagnosed around 55±13.2 months after the surgery. The average age of the study participants was about 41±10.8 years, with females making up 51.2% of the subjects. In terms of racial distribution, 34.10% were African Americans, 27.5% were Whites, 19.5% were Hispanics, and 18.9% were Asians. Remarkably, White patients exhibited the onset of Crohn’s in a significantly shorter timeframe compared to other racial groups (Breslow: 11.836, p=0.022). Moreover, an elevated risk of Crohn’s was noted among those with a pre-op BMI < 45 (OR: 2.25, P=0.03).
Conclusions:
This study addresses the existing gap in knowledge surrounding the impact of race on the development of Crohn’s disease post-bariatric surgery. Our retrospective review of 960 surgical procedures conducted from 2009 to 2022 revealed a 0.03% incidence of Crohn’s, typically detected around 55 months postoperatively. Significantly, White patients manifested symptoms of Crohn’s within a substantially shorter duration as compared to their counterparts from other racial backgrounds, with those possessing a preoperative BMI < 45 displaying heightened risks. These findings underscore the pivotal role of racial and other socio-demographic factors in optimizing post-surgical care. Ongoing research in this area is crucial to formulate strategies to mitigate these risks, aiming to enhance health outcomes across diverse patient populations.
