Autoimmune disease and bariatric surgery

Question
Is autoimmune disease a contraindication for any of the procedures?  I have FM, and possibly SLE and/or Sjogren's.  My ANA is elevated.  I have healed well from surgeries in the past.  I had massive problems with dental work earlier this year- had 5 root canals that did not heal due to massive inflammation, had to be temporarily packed for over 6 months, and am still having problems with swelling in such a small space.  I have to take NSAIDS and steroids intermittently for that and also rheumatology issues.  I would think that a sleeve would be best due to these factors, but not covered by insurance unless my surgeon can support this argument during the appeals process.  I am concerned about massive inflammation with any foreign body or stoma situation- possibly ruling out the lap band or gastric bypass. Also, I have heard that you are not to use NSAID post bypass- does this go for lap band as well? I am hoping that none of my hx would keep me from being a good candidate for the sleeve, and that the surgeon can provide enough evidence of this to insurance, should thar be the case.  Thanks for your help!!

Answer
Lisa,
First, I confess that I don't know what diagnosis "FM" stands for, but since I understand SLE, Sjogren's, and autoimmune disease I think I still get the idea.  :)

One side comment before I answer your question - surgical weight loss will not 'cure' your autoimmune conditions, but it is quite likely to decrease your total body inflammatory level and make your other conditions easier to treat/control.  In other words, you should have fewer flares that should be less severe as you lose weight.

I do understand that, in spite of the anticipated improvements through weight loss, it is quite likely that you will need to use NSAIDs of some type over time.  It is not universally agreed among surgeons, but most of us have seen NSAIDs cause persisting bleeding ulcers in gastric bypass patients, so we strongly recommend avoiding NSAIDs for that group.  

I am not aware of any data indicating that a gastric band causes a direct allergic reaction or that it worsens flares of existing autoimmune diseases, but the concern continues and since overall Band results are less beneficial than other operations I agree it is best not to pursue it in your case.  Unlike patients with a gastric bypass, Band patients do not seem to have an increased rate of complications from NSAIDs.

Based on the information you've provided, the Sleeve does sound like a reasonable option.  Certainly, it is the option I would recommend for a patient with the characteristics you have described.  I would be hopeful that your surgeon can convince the insurance reviewer of this opinion during a "peer-to-peer" discussion.

Best of luck!
Dr JP

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