Celiac Disease and Obesity: Is Bariatric Surgery an Option?
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REVIEW
Celiac Disease and Obesity: Is Bariatric Surgery an Option? Manon Lojou 1 & Nicolas Sahakian 1 & Anne Dutour 1,2 & Geoffroy Vanbiervliet 3 & Thierry Bege 4,5 & Bénédicte Gaborit 1,2,6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Celiac disease is an immune-mediated enteropathy associated with malabsorptive syndrome and fat-soluble vitamin deficiencies. Celiac disease affects 1% 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 celiac disease 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 celiac disease, 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 celiac disease. Keywords Celiac disease . Bariatric surgery . Obesity . Gluten-free diet . Roux-en-Y bypass . Sleeve gastrectomy
Introduction Celiac disease (CD) is an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in small intestine [1]. It is characterized by villous atrophy inducing a malabsorption syndrome [2]. Celiac disease was classically defined in the child as a chronic enteropathy with villous atrophy secondary to an inappropriate immune response of the intestinal mucosa to the gliadin in wheat, barley, and rye. The disorder often presents with diarrhea, malabsorption of one or more nutrients, and resultant weight loss, * Bénédicte Gaborit [email protected] 1
Department of Endocrinology, Metabolic Disease and Nutrition, Assistance Publique–Hôpitaux de Marseille, Marseille, France
2
INSERM, INRAE, C2VN, Aix-Marseille University, Marseille, France
3
Digestive Medicine, L’Archet 2 University Hospital–Nice, Nice, France
4
Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915 Marseille Cedex 20, France
5
IFSTTAR, LBA, Aix-Marseille University, Marseille, France
6
Department of Endocrinology, Metabolic Disease and Nutrition, Pole ENDO, Hôpital Nord, Chemin des Bourrely, 13915 Marseille Cedex 20, France
and it involves a mucosal inflammatory response that extends from the duodenum into the more distal small intestine for variable distances. Celiac disease is heavily underdiagnosed, due to its many variable clinical symptoms and multi-organ manifestations (Fig. 1). Diagnosis of celiac disease is based on the presence of predisposing genetic factor human leukocyte antigen (HLA) DQ2/8 haplotypes, with positive small intestine biopsy and serological antibodies upon a gluten-containing diet [3]. Histological confirmation of c
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