Clinical onset of celiac disease after duodenal switch: a case report

Pané, Adriana; Orois, Aida; Careaga, M; Saco, Adela; Ortega, Emilio; Vidal, Josep; Leyes, Pere; Amor, Antonio J.

doi:10.1038/ejcn.2016.65

Cited by 8 publications

(9 citation statements)

References 10 publications

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“…No large-scale studies so far have investigated bariatric surgery in this patient population and there is a paucity of data regarding the impact of bariatric surgery on the outcomes of obese patients with celiac disease. Moreover, there are some case reports suggesting that patients may develop gluten intolerance or even celiac disease after the bariatric procedure, raising questions and concerns about the true benefits of this procedure [13,14].…”

Section: Introductionmentioning

confidence: 99%

Impact of bariatric surgery on outcomes of patients with celiac disease: a nationwide inpatient sample analysis, 2004-2014

Sharma

McCarty

Lange

et al. 2018

aog

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BackgroundWhile patients with celiac disease have increasingly developed an atypical pattern of weight gain and obesity, the role of bariatric surgery remains unclear. The primary aim of this study was to evaluate the effect of bariatric surgery on clinical outcomes among hospitalized patients with celiac disease.MethodsThe United States Nationwide Inpatient Sample database was queried for discharges with co-diagnoses of morbid obesity and celiac disease between 2004 and 2014. The primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, micronutrient deficiency, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior bariatric surgery compared to those without bariatric surgery.ResultsAmong 1499 patients with a discharge diagnosis of celiac disease and morbid obesity, 126 patients (8.4%) underwent bariatric surgery. Despite an increase in morbid obesity over the study period, the proportion of morbidly obese patients with celiac disease who had bariatric surgery declined by 18.5% (Ptrend<0.05). On multivariable analysis, bariatric surgery did not influence mortality (P=0.98), but was associated with a lower risk of renal failure, pneumonia, sepsis, urinary tract infection and respiratory failure (all P<0.05). Bariatric surgery increased the risk of vitamin D deficiency (IRR 3.5; 95% confidence interval [CI] 1.6-7.7; P=0.002) and post-operative strictures (IRR 3.3; 95%CI 1.5-7.5; P=0.004).ConclusionDespite the underutilization of bariatric surgery in morbidly obese celiac disease patients, the procedure is safe and appears to significantly reduce morbidity.

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Section: Introductionmentioning

confidence: 99%

Impact of bariatric surgery on outcomes of patients with celiac disease: a nationwide inpatient sample analysis, 2004-2014

Sharma

McCarty

Lange

et al. 2018

aog

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“…Four case reports 10-12,16 outlined patients experiencing either nausea, vomiting, diarrhea, and, in 1 instance, 10 mental status fluctuations and eventual death following bariatric surgery (Table 2). In all cases, post-operative biopsies demonstrated jejunal villous atrophy and crypt hyperplasia, and a diagnosis of CD 11,12,16 or subclinical CD 10 were made. Marini et al, 11 Owen et al, 12 and Pané et al 16 reported symptom alleviation following implementation of a GFD.…”

Section: Resultsmentioning

confidence: 99%

“…In patients with a post-operative CD diagnosis, persistent diarrhea, vomiting, malodorous stools, clinically severe weight loss, abdominal pain, and hospitalization occurred. [10][11][12]16 Although these patients returned to near or fully asymptomatic levels following their post-operative diagnosis and introduction of a GFD, they experienced a myriad of additional symptoms than those with a pre-operative CD diagnosis. Comparatively, patients with pre-operative CD diagnoses appeared to have unremarkable post-operative courses following either RYGB or SG.…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease and Bariatric Surgery: A Systematic Review of Current Literature

Richard

Mocanu

Verhoeff

et al. 2022

Foregut: The Journal of the American Foregut Society

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Background: Celiac disease (CD) is a clinical entity increasingly recognized in the severe obese population and its impact on outcomes following bariatric surgery is not currently understood. We aimed to systematically review the nutritional and clinical outcomes for patients with obesity and CD following bariatric surgery. Methods: Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in September 2021. Study followed PRISMA guidelines. Studies evaluating adult patients with CD undergoing bariatric surgery were included. Outcomes were descriptive due to limited studies. Results: Our literature review produced 9 studies with 152 patients. The weighted mean age of included patients was 44.2 years (±9.55 years) and 98% (n = 149) were female. Patients diagnosed with CD post-operatively appear to experience substantial perioperative and nutritional complications following bariatric surgery. However, pre-operative diagnosis may allow patient optimization and current studies suggest similar bariatric surgery outcomes can be achieved in these patients when the diagnosis is known. However, this study also highlights a scarcity of evidence evaluating the rate of CD and outcomes for these patients after bariatric surgery. Conclusion: Current literature lacks quality, comparative studies investigating the short- and long-term surgical complications and nutritional outcomes of bariatric surgery within patients who have co-diagnoses of obesity and CD. Despite these limitations, our group recommends pre-operative CD screening in patients experiencing either classical GI symptoms of CD including diarrhea, steatorrhea, bloating, or undifferentiated abdominal pain.

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“…Final diagnosis was later made based on anti-transglutaminase antibodies. The authors suggest that CD should be ruled out in patients with typical or atypical symptoms after BS regardless of the latency of onset [46]. Another asymptomatic case reported after vertical banded gastroplasty was due to familial history [44].…”

Section: Is There Increased Incidence Of CD After Bariatric Surgery?mentioning

confidence: 98%

Celiac Disease and Obesity: Is Bariatric Surgery an Option?

Lojou¹,

Sahakian²,

Dutour³

et al. 2020

OBES SURG

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Celiac disease (CD) is an immune-mediated enteropathy associated with malabsorptive syndrome and fat-soluble vitamin deficiencies. CD affects one percent of individuals but is largely underdiagnosed, as its multifaceted clinical presentations create challenging diagnostic scenarios. With the rise of the obesity epidemic, doctors are increasingly seeing CD patients with overweight or obesity, which raises the question of bariatric surgery. However, few studies so far have investigated bariatric surgery in this patient population. Here we provide a comprehensive review of the literature on CD, its nutritional consequences and complications, and we discuss the possible impact of bariatric surgery on weight loss, nutritional deficiencies, response to gluten-free diet, and long-term post-operative complications. We also review the effect of bariatric surgery on the incidence of CD.

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Clinical onset of celiac disease after duodenal switch: a case report

Cited by 8 publications

References 10 publications

Impact of bariatric surgery on outcomes of patients with celiac disease: a nationwide inpatient sample analysis, 2004-2014

Impact of bariatric surgery on outcomes of patients with celiac disease: a nationwide inpatient sample analysis, 2004-2014

Celiac Disease and Bariatric Surgery: A Systematic Review of Current Literature

Celiac Disease and Obesity: Is Bariatric Surgery an Option?

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