Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases?

Abstract

Bariatric procedures are an effective option for weight loss and control of comorbidities in obese patients. Obesity is a proinflammatory condition in which some cytokines such as leptin, a proinflammatory protein, is elevated and adiponectin, an anti-inflammatory protein, is decreased. In patients undergoing weight reduction surgeries, these hormone levels behave paradoxically. It is not known whether bariatric surgery protects against development of autoinflammatory or autoimmune conditions; nevertheless, changes occurring in the immune system are incompletely understood. In this case series, we describe 4 patients undergoing bariatric surgery, who subsequently developed systemic autoimmune diseases. Patients in our case series were asymptomatic before surgery and developed an autoimmune disease within 11.2 months. Two women fulfilled criteria for systemic lupus erythematosus (one associated with antiphospholipid syndrome), and 2 men developed rheumatoid arthritis. A causal relationship is difficult to establish because factors that could trigger these diseases are multiple, including genetic susceptibility, time elapsed until achievement of ideal weight, and vitamin deficiencies, among others. However, clinicians must be attentive to this possible association.

Multiple sclerosis following bariatric surgery: A report of five cases

“…Bitarafan et al reported four patients who developed MS after severe intentional weight loss, which was attributed to result from an inflammatory process. 7 Furthermore, four patients have been reported to develop systemic lupus erythematosus and rheumatoid arthritis, which are autoimmune diseases, after significant weight loss 20 Our case series is consistent with these findings since all our patients were diagnosed with MS, which is also an autoimmune disease, after an average of two years of undergoing different bariatric surgeries.…”

Bariatric surgery is associated with increased risk of new‐onset inflammatory bowel disease: case series and national database study

“…Recently, there have been case reports of patients developing CD following bariatric surgery . Interestingly, there have also been reports of immune‐mediated diseases occurring after weight loss surgery . In order to explore the possible relationship between bariatric surgery and IBD, we first compiled a multicentre descriptive case series.…”

“…[10][11][12][13][14] Interestingly, there have also been reports of immune-mediated diseases occurring after weight loss surgery. 15 In order to explore the possible relationship between bariatric surgery and IBD, we first compiled a multicentre descriptive case series. We subsequently examined the association between prior bariatric surgery and risk of new-onset IBD in a large health claims database.…”

Autoantibodies production and immunological abnormalities after bariatric surgery

“…However, the role of weight loss on the immune system is still controversial and even more when weight loss can be massive and fast. In a previous article by our group, we described the development of autoimmune diseases following weight loss associated with bariatric surgery [ 2 ]. In addition, some cases reported in the world literature have shown that a marked decrease in body mass index (BMI) might possibly trigger autoimmunity-related rheumatologic syndromes and metabolic processes resulting mainly from rapid weight loss [ 2 ].…”

“…In a previous article by our group, we described the development of autoimmune diseases following weight loss associated with bariatric surgery [ 2 ]. In addition, some cases reported in the world literature have shown that a marked decrease in body mass index (BMI) might possibly trigger autoimmunity-related rheumatologic syndromes and metabolic processes resulting mainly from rapid weight loss [ 2 ]. Currently, the effects of bariatric surgery on the immune system, including the different T and B cell subpopulations, autoantibodies, complement and markers of inflammatory activity are unknown.…”