Title: Choosing the Knife, OBESITY or IBD? Another Case of Crohn’s Following Roux En-Y Gastric Bypass Surgery!
INTRODUCTION
Bariatric surgery increases the incidence of gastrointestinal (GI) complications, including acid reflux (GERD), malabsorption, gastric ulcers and chronic diarrhea. Literature indicates few cases of patients being diagnosed with Inflammatory Bowel Disease (IBD) after bariatric surgery. The mechanisms are not well understood, however several hypotheses have emerged.
CASE
A 34 year old Hispanic female with no significant medical history, presented with a significant amount of weight (50kg) and abdominal pain, approximately 1 year after she underwent Roux-en-Y gastric bypass surgery. She also complained of multiple upper GI manifestations, including GERD, malabsorption, and gastric ulcer following the procedure.
A year after the operation, she also started to experience episodes of abdominal pain on the Right Lower Quadrant (RLQ), and bloody mucous filled diarrhea. An appendectomy was done and since the symptoms persisted, colonoscopy was performed, which revealed chronic active colitis with cryptitis, cypt abscesses, and mild glandular distortion without granuloma. A diagnosis of Crohn’s disease was made given the …show more content…
IBD is an unpredictable disease with magnitude of possible serious complications and variable clinical outcomes even when treated. These patients are often misdiagnosed due to wide range of GI symptoms. Early diagnosis is crucial, but most importantly IBD must be prevented when possible. Since we have growing evidence of that gastric bypass might be a precipitator of IBD, we need better molecular and clinical predictors and indices for development of post operative IBD. Therefore we can enhance the informed decision, in regard to the individual risk and benefit of that patient undergoing bariatric
INTRODUCTION
Bariatric surgery increases the incidence of gastrointestinal (GI) complications, including acid reflux (GERD), malabsorption, gastric ulcers and chronic diarrhea. Literature indicates few cases of patients being diagnosed with Inflammatory Bowel Disease (IBD) after bariatric surgery. The mechanisms are not well understood, however several hypotheses have emerged.
CASE
A 34 year old Hispanic female with no significant medical history, presented with a significant amount of weight (50kg) and abdominal pain, approximately 1 year after she underwent Roux-en-Y gastric bypass surgery. She also complained of multiple upper GI manifestations, including GERD, malabsorption, and gastric ulcer following the procedure.
A year after the operation, she also started to experience episodes of abdominal pain on the Right Lower Quadrant (RLQ), and bloody mucous filled diarrhea. An appendectomy was done and since the symptoms persisted, colonoscopy was performed, which revealed chronic active colitis with cryptitis, cypt abscesses, and mild glandular distortion without granuloma. A diagnosis of Crohn’s disease was made given the …show more content…
IBD is an unpredictable disease with magnitude of possible serious complications and variable clinical outcomes even when treated. These patients are often misdiagnosed due to wide range of GI symptoms. Early diagnosis is crucial, but most importantly IBD must be prevented when possible. Since we have growing evidence of that gastric bypass might be a precipitator of IBD, we need better molecular and clinical predictors and indices for development of post operative IBD. Therefore we can enhance the informed decision, in regard to the individual risk and benefit of that patient undergoing bariatric