Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies

Ying, Valerie Wu Chao; Kim, Song Hon H.; Khan, Khurram J.; Farrokhyar, Forough; D’Souza, Joanne; Gmora, Scott; Anvari, Mehran; Hong, Dennis

doi:10.1007/s00464-014-3794-1

Cited by 89 publications

(22 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, in minimizing the risk for MU development in bariatric surgery, there is an increasing trend to administer PPI as a postoperative prophylaxis. However, neither a clear consensus on the duration of such treatment (30 or 90 days) nor solid evidence of its effect in the long term exists [ 20 , 22 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Abdominal pain is most common symptom of MU, whereas other symptoms include gastrointestinal bleeding or anemia and dysphagia due to stricture [ 15 , 17 , 19 ]. The diagnosis of MU is confirmed with upper endoscopy, but a significant proportion of patients with symptoms suggestive of MU are empirically treated by proton pump inhibitors (PPI) [ 15 , 17 , 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients

Bekhali

Sundbom

2020

OBES SURG

View full text Add to dashboard Cite

Purpose Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors. Methods A cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received a questionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs) for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery (SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU. Results After a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41 MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the most common symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according to SOReg-data. Persisting PPI treatment was seen in about three quarter of former MU patients (OR 11.2 [3.6–34.7], p < 0.001), but no other associative factors were found. Conclusion The overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. Ongoing PPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for future bariatric surgery candidates.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients

Bekhali

Sundbom

2020

OBES SURG

View full text Add to dashboard Cite

show abstract

“…A meta-analysis of three cohort studies that compared the comparative effect of PPIs on marginal ulcers suggested beneficial effect of PPI treatment (OR 0.50, 95% CI 0.29 to 0.90, moderate certainty) ( Supplementary Table S34) [131]. Under consideration of the risk/benefit ratio, the low cost and acceptability of the intervention, the panel provided a strong recommendation.…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

View full text Add to dashboard Cite

Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

show abstract

“…Thus, direct malabsorption of calcium may result, independent of vitamin D status. Further, calcium absorption could be impaired due to achlorhydria from the operation itself and from the common use of proton pump inhibitors for the prevention of marginal ulcers [79,80]. Alternatively, one might hypothesize that sufficient calcium absorption capacity could be maintained after RYGB, if vitamin D status and calcium intake are robust.…”

Section: Intestinal Calcium Transport After Bariatric Surgerymentioning

confidence: 99%

Vitamin D and intestinal calcium transport after bariatric surgery

Schafer

2017

The Journal of Steroid Biochemistry and Molecular Biology

View full text Add to dashboard Cite

Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients.

show abstract

Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies

Abstract: This finding suggests a significant incremental benefit of prophylactic PPI in reducing marginal ulcer after gastric bypass surgery. Prospective randomized trials are needed to further define the role of PPI following gastric bypass surgery.

Cited by 89 publications

References 12 publications

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

Vitamin D and intestinal calcium transport after bariatric surgery

Contact Info

Product

Resources

About