Bariatric Procedures Unmasking Celiac Disease

Celiac disease is being recognized more frequently but often remains undiagnosed. Celiac disease patients are increasingly obese. Major operation in patients with celiac disease may cause symptoms which lead to the diagnosis, termed “unmasking.” We report three patients undergoing bariatric procedures which led to unmasking. Three patients undergoing bariatric procedures for morbid obesity were subsequently diagnosed with celiac disease. A 42-yearold female underwent gastric bypass. Her body mass index was 77 preoperatively and open gastric bypass with a 150 cm Roux Limb was performed. At 18 months her body mass index was 51 and she had no diarrhea. A malabsorptive revision moved the Roux Limb connection to 60 cm proximal to the cecum. One year later she had a body mass index of 36 and diarrhea. Persistent diarrhea and weight loss in the following two years led to serologic diagnosis of celiac disease. On a gluten-free diether diarrhea improved and her weight increased 6 kg. A 30-year-old female underwent gastric band. Her body mass index was 46 preoperatively. After multiple adjustments a band slip repair was performed at two years and the band was removed at four years. Body mass index was 42 at that time. Within a few months she developed early satiety, abdominal pain and distension, and hepatomegaly. Serology and histology diagnosed celiac disease and a gluten-free diet was instituted. A 36-year-old female underwent biliopancreatic diversion. Her body mass index was 48 preoperatively and decreased to 22 in two years. Persistent diarrhea led to serologic evaluation for celiac disease. She was started on a gluten-free diet and her body mass index increased to 27 at five years and 30 at ten years postoperatively. Celiac disease should be suspected and evaluated in patients who develop suggestive symptoms after bariatric procedures, including those associated with malabsorption.