title: The bariatric surgery patient: lost to follow-up; from morbid obesity to severe malnutrition.
abstract: OBJECTIVE
  To describe the potential long-term risk of malnutrition after Roux-en-Y gastric bypass (GBP) through an uncommon occurrence of inflammatory bowel disease (IBD) postoperatively, which posed a serious threat to the nutritional status and the life of the patient.
  
  
  METHODS
  We present a case report of a 44-year-old woman in whom Crohn disease developed 4 years after she had undergone GBP. The double insult of IBD and GBP resulted in severe malnutrition, with a serum albumin concentration of 0.9 g/dL (reference range, 3.5 to 5.0), weight loss, and watery diarrhea necessitating 6 hospital admissions during a period of 7 months.
  
  
  RESULTS
  Ultimately, the administration of total parenteral nutrition with aggressive macronutrient, vitamin, and mineral repletion resulted in substantial improvement in the patient's strength, function, and quality of life, in parallel with diminished symptoms of IBD.
  
  
  CONCLUSIONS
  Rarely, IBD develops after GBP, but the relationship between the 2 conditions remains unclear. Regardless, in addition to the altered anatomy after bariatric surgery, the further insult of IBD poses a severe threat to the nutritional status of affected patients. Malnutrition needs to be recognized and aggressively treated. Nutritional markers should be followed closely in this population of bariatric patients in an effort to avert the onset of severe malnutrition.
authors.affiliation: Division of Endocrinology, Diabetes and Nutrition, St. Luke's Roosevelt Hospital Center, New York, New York 10025, USA. gdodell@chpnet.org
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Dodell
authors.forename: Jeanine B
authors.initials: JB
authors.lastname: Albu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Attia
authors.forename: James
authors.initials: J
authors.lastname: McGinty
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: Blandine
authors.initials: B
authors.lastname: Laferrère
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016312:Treatment Refusal