{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T08:26:23Z","timestamp":1768465583150,"version":"3.49.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:00:00Z","timestamp":1743206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100023360","name":"St Vincent's Hospital Melbourne","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023360","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>ApoA\u2010IV amyloidosis is a rare disease that involves the deposition of ApoA-IV protein aggregates in tissues. It commonly presents as cardiac or renal disease, but can, in rare cases, cause small bowel perforation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study describes a case of ApoA-IV type amyloidosis causing small bowel perforation after conversion of a sleeve gastrectomy (SG) into a RYGB in a Crohn\u2019s disease (CD) and rheumatoid arthritis (RA) patient. It also considers the indications for\u00a0bariatric and anti-reflux surgery in the setting of co-morbid inflammatory bowel disease (IBD), gastro-oesophageal reflux disease (GORD), and obesity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Obesity can reduce the efficacy of IBD medications and drives a pro-inflammatory state that may worsen IBD, however IBD patients present an operative challenge due to risk of more intestinal adhesions, potential intolerance to intestinal bypass, and risk of affecting options for future bowel resections if required. SG is often chosen over RYGB\u00a0for CD\u00a0patients due to limited short-term complications. However, when considering co-morbid GORD, the long-term risk of medication resistant GORD, erosive oesophagitis, and Barrett\u2019s oesophagus with SG is significant, especially given that SG is an irreversible procedure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>There is growing evidence that bariatric surgery in IBD patients is both safe and effective, however the decision to perform bariatric surgery in an IBD patient involves consideration of the intricate interplay between obesity and IBD. <\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11695-025-07814-8","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T14:58:35Z","timestamp":1743433115000},"page":"1679-1684","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Small Bowel Perforation in Roux-en-Y Gastric Bypass (RYGB) Secondary to Apolipoprotein A-IV (AApoA-IV) Type Amyloidosis"],"prefix":"10.1007","volume":"35","author":[{"given":"Mona Zhi Ling Mai","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefaan","family":"De Clercq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,29]]},"reference":[{"key":"7814_CR1","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1159\/000262276","volume":"2","author":"H Steed","year":"2009","unstructured":"Steed H, Walsh S, Reynolds N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside. Scotland Obes Facts. 2009;2:370\u20132.","journal-title":"Scotland Obes Facts"},{"key":"7814_CR2","doi-asserted-by":"publisher","first-page":"2436","DOI":"10.1007\/s10620-015-3629-5","volume":"60","author":"A Flores","year":"2015","unstructured":"Flores A, Burstein E, Cipher DJ, et al. Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci. 2015;60:2436\u201345.","journal-title":"Dig Dis Sci"},{"key":"7814_CR3","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1097\/DCR.0b013e3182342ccb","volume":"54","author":"MW Causey","year":"2011","unstructured":"Causey MW, Johnson EK, Miller S, et al. The impact of obesity on outcomes following major surgery for Crohn\u2019s disease: An American college of surgeons national surgical quality improvement program assessment. Dis Colon Rectum. 2011;54:1488\u201395.","journal-title":"Dis Colon Rectum"},{"key":"7814_CR4","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1007\/s11695-015-1909-y","volume":"26","author":"A Aminian","year":"2016","unstructured":"Aminian A, Andalib A, Ver MR, et al. Outcomes of bariatric surgery in patients with inflammatory bowel disease. OBES SURG. 2016;26:1186\u201390.","journal-title":"OBES SURG"},{"key":"7814_CR5","doi-asserted-by":"publisher","first-page":"3783","DOI":"10.1007\/s11695-018-3450-2","volume":"28","author":"L Angrisani","year":"2018","unstructured":"Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: Primary, endoluminal, and revisional procedures. OBES SURG. 2018;28:3783\u201394.","journal-title":"OBES SURG"},{"key":"7814_CR6","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1007\/s11695-017-3076-9","volume":"28","author":"S Aelfers","year":"2018","unstructured":"Aelfers S, Janssen IMC, Aarts EO, et al. Inflammatory bowel disease is not a contraindication for bariatric surgery. OBES SURG. 2018;28:1681\u20137.","journal-title":"OBES SURG"},{"key":"7814_CR7","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.surg.2023.04.059","volume":"174","author":"A Wallhuss","year":"2023","unstructured":"Wallhuss A, Ottosson J, Cao Y, et al. Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: a nationwide registry-based cohort study. Surgery. 2023;174:144\u201351.","journal-title":"Surgery"},{"key":"7814_CR8","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1093\/ibd\/izz236","volume":"26","author":"MB Braga Neto","year":"2020","unstructured":"Braga Neto MB, Gregory MH, Ramos GP, et al. Impact of bariatric surgery on the long-term disease course of inflammatory bowel disease. Inflamm Bowel Dis. 2020;26:1089\u201397.","journal-title":"Inflamm Bowel Dis"},{"key":"7814_CR9","doi-asserted-by":"publisher","first-page":"3872","DOI":"10.1007\/s11695-020-04729-4","volume":"30","author":"R Garg","year":"2020","unstructured":"Garg R, Mohan BP, Ponnada S, et al. Safety and efficacy of bariatric surgery in inflammatory bowel disease patients: a systematic review and meta-analysis. OBES SURG. 2020;30:3872\u201383.","journal-title":"OBES SURG"},{"key":"7814_CR10","doi-asserted-by":"publisher","first-page":"e12405","DOI":"10.1111\/cob.12405","volume":"10","author":"M Aziz","year":"2020","unstructured":"Aziz M, Haghbin H, Sharma S, et al. Safety of bariatric surgery in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Obes. 2020;10:e12405.","journal-title":"Clin Obes"},{"key":"7814_CR11","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1159\/000496925","volume":"3","author":"JL Hudson","year":"2018","unstructured":"Hudson JL, Barnes EL, Herfarth HH, et al. Bariatric surgery is a safe and effective option for patients with inflammatory bowel diseases: a case series and systematic review of the literature. Inflamm Intest Dis. 2018;3:173\u20139.","journal-title":"Inflamm Intest Dis"},{"key":"7814_CR12","unstructured":"Bustamante JG, Zaidi SRH. Amyloidosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025\u00a0[cited 2025 Feb 04]. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470285\/."},{"key":"7814_CR13","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1007\/s10620-012-2549-x","volume":"58","author":"PT Sattianayagam","year":"2013","unstructured":"Sattianayagam PT, Gillmore JD, Pinney JH, et al. Inflammatory bowel disease and systemic AA amyloidosis. Dig Dis Sci. 2013;58:1689\u201397.","journal-title":"Dig Dis Sci"},{"key":"7814_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4253\/wjge.v13.i1.1","volume":"13","author":"DS Dahiya","year":"2021","unstructured":"Dahiya DS, Kichloo A, Singh J, et al. Gastrointestinal amyloidosis: A focused review. WJGE. 2021;13:1\u201312.","journal-title":"WJGE"},{"issue":"10","key":"7814_CR15","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1093\/ecco-jcc\/jjw080","volume":"10","author":"J Tosca Cuquerella","year":"2016","unstructured":"Tosca Cuquerella J, Bosca-Watts MM, Anton Ausejo R, et al. Amyloidosis in inflammatory bowel disease: a systematic review of epidemiology, clinical features, and treatment. J Crohn\u2019s Colitis. 2016;10(10):1245\u201353.","journal-title":"J Crohn's Colitis"},{"key":"7814_CR16","doi-asserted-by":"publisher","first-page":"155682","DOI":"10.1016\/j.prp.2024.155682","volume":"264","author":"Y Hamamoto","year":"2024","unstructured":"Hamamoto Y, Kido K, Kawamura M, et al. Subclinical amyloid deposition in inflammatory bowel diseases: a two hospital study. Pathol - Res Pract. 2024;264:155682.","journal-title":"Pathol - Res Pract"},{"key":"7814_CR17","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1007\/s12328-024-02003-z","volume":"17","author":"VS Gill","year":"2024","unstructured":"Gill VS, Boddu SP, Abujbarah S, et al. Secondary amyloidosis in inflammatory bowel disease patients: findings from three tertiary medical centers. Clin J Gastroenterol. 2024;17:844\u201353.","journal-title":"Clin J Gastroenterol"},{"key":"7814_CR18","first-page":"404","volume":"33","author":"O Fikri-Benbrahim","year":"2013","unstructured":"Fikri-Benbrahim O, Rivera-Hern\u00e1ndez F, Mart\u00ednez-Calero A, et al. Treatment with adalimumab in amyloidosis secondary to rheumatoid arthritis: two case reports. Nefrologia. 2013;33:404\u20139.","journal-title":"Nefrologia"},{"key":"7814_CR19","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.3899\/jrheum.090101","volume":"36","author":"T Kuroda","year":"2009","unstructured":"Kuroda T, Wada Y, Kobayashi D, et al. Effective anti-TNF-\u03b1 therapy can induce rapid resolution and sustained decrease of gastroduodenal mucosal amyloid deposits in reactive amyloidosis associated with rheumatoid arthritis. J Rheumatol. 2009;36:2409\u201315.","journal-title":"J Rheumatol"},{"key":"7814_CR20","doi-asserted-by":"publisher","first-page":"7973","DOI":"10.1016\/S0021-9258(18)47513-8","volume":"262","author":"NA Elshourbagy","year":"1987","unstructured":"Elshourbagy NA, Walker DW, Paik YK, et al. Structure and expression of the human apolipoprotein A-IV gene. J Biol Chem. 1987;262:7973\u201381.","journal-title":"J Biol Chem"},{"issue":"6","key":"7814_CR21","doi-asserted-by":"publisher","first-page":"G628","DOI":"10.1152\/ajpgi.00225.2011","volume":"302","author":"AB Kohan","year":"2012","unstructured":"Kohan AB, Wang F, Li X, et al. Apolipoprotein A-IV regulates chylomicron metabolism\u2013mechanism and function. Am J Physiol-Gastrointest Liver Physiol. 2012;302(6):G628\u201336.","journal-title":"Am J Physiol-Gastrointest Liver Physiol"},{"key":"7814_CR22","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/S0021-9150(99)00395-0","volume":"151","author":"Z Sun","year":"2000","unstructured":"Sun Z, Larson IA, Ordovas JM, et al. Effects of age, gender, and lifestyle factors on plasma apolipoprotein A-IV concentrations. Atherosclerosis. 2000;151:381\u20138.","journal-title":"Atherosclerosis"},{"issue":"12","key":"7814_CR23","first-page":"001237","volume":"6","author":"E Martins","year":"2019","unstructured":"Martins E, Urbano J, Leite S, et al. Cardiac amyloidosis associated with apolipoprotein A-IV deposition diagnosed by mass spectrometry-based proteomic analysis. Eur J Case Rep Intern Med. 2019;6(12):001237.","journal-title":"Eur J Case Rep Intern Med"},{"key":"7814_CR24","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/j.kint.2016.04.003","volume":"90","author":"S Dasari","year":"2016","unstructured":"Dasari S, Amin MS, Kurtin PJ, et al. Clinical, biopsy, and mass spectrometry characteristics of renal apolipoprotein A-IV amyloidosis. Kidney Int. 2016;90:658\u201364.","journal-title":"Kidney Int"},{"key":"7814_CR25","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1002\/path.5770","volume":"255","author":"D Canetti","year":"2021","unstructured":"Canetti D, Nocerino P, Rendell NB, et al. Clinical ApoA-IV amyloid is associated with fibrillogenic signal sequence. J Pathol. 2021;255:311\u20138.","journal-title":"J Pathol"},{"key":"7814_CR26","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1080\/13506129.2022.2147636","volume":"29","author":"JN Buxbaum","year":"2022","unstructured":"Buxbaum JN, Dispenzieri A, Eisenberg DS, et al. Amyloid nomenclature 2022: update, novel proteins, and recommendations by the International Society of Amyloidosis (ISA) Nomenclature Committee. Amyloid. 2022;29:213\u20139.","journal-title":"Amyloid"},{"key":"7814_CR27","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1038\/ki.2011.316","volume":"81","author":"S Sethi","year":"2012","unstructured":"Sethi S, Theis JD, Shiller SM, et al. Medullary amyloidosis associated with apolipoprotein A-IV deposition. Kidney Int. 2012;81:201\u20136.","journal-title":"Kidney Int"},{"key":"7814_CR28","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.1016\/j.jacc.2017.02.047","volume":"69","author":"MC Bois","year":"2017","unstructured":"Bois MC, Dasari S, Mills JR, et al. Apolipoprotein A-IV\u2013associated cardiac amyloidosis. J Am Coll Cardiol. 2017;69:2248\u20139.","journal-title":"J Am Coll Cardiol"},{"key":"7814_CR29","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1093\/bjs\/znab330","volume":"108","author":"A Genco","year":"2021","unstructured":"Genco A, Castagneto-Gissey L, Gualtieri L, et al. GORD and Barrett\u2019s oesophagus after bariatric procedures: multicentre prospective study. Br J Surg. 2021;108:1498\u2013505.","journal-title":"Br J Surg"},{"key":"7814_CR30","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1007\/s00423-024-03341-9","volume":"409","author":"O Thaher","year":"2024","unstructured":"Thaher O, Wollenhaupt F, Croner RS, et al. Evaluation of the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in patients with morbid obesity: multicenter comparative study. Langenbecks Arch Surg. 2024;409:156.","journal-title":"Langenbecks Arch Surg"},{"key":"7814_CR31","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/j.bpg.2014.07.010","volume":"28","author":"J Tack","year":"2014","unstructured":"Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol. 2014;28:741\u20139.","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"7814_CR32","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1097\/SLA.0000000000003275","volume":"271","author":"KTD Yeung","year":"2020","unstructured":"Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis. Ann Surg. 2020;271:257\u201365.","journal-title":"Ann Surg"},{"key":"7814_CR33","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.soard.2023.10.006","volume":"20","author":"RM Mabeza","year":"2024","unstructured":"Mabeza RM, Vadlakonda A, Chervu N, et al. Short-term outcomes of bariatric surgery in patients with inflammatory bowel disease: a national analysis. Surg Obes Relat Dis. 2024;20:146\u201352.","journal-title":"Surg Obes Relat Dis"},{"key":"7814_CR34","doi-asserted-by":"publisher","first-page":"7868","DOI":"10.3748\/wjg.v22.i35.7868","volume":"22","author":"JW Harper","year":"2016","unstructured":"Harper JW, Zisman TL. Interaction of obesity and inflammatory bowel disease. WJG. 2016;22:7868.","journal-title":"WJG"},{"key":"7814_CR35","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1038\/nrgastro.2016.181","volume":"14","author":"S Singh","year":"2017","unstructured":"Singh S, Dulai PS, Zarrinpar A, et al. Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes. Nat Rev Gastroenterol Hepatol. 2017;14:110\u201321.","journal-title":"Nat Rev Gastroenterol Hepatol"}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-07814-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-025-07814-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-07814-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T18:18:41Z","timestamp":1746901121000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-025-07814-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,29]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["7814"],"URL":"https:\/\/doi.org\/10.1007\/s11695-025-07814-8","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"value":"0960-8923","type":"print"},{"value":"1708-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,29]]},"assertion":[{"value":"7 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in this study were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from the study participant.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interest"}}]}}