Advertisement

Surgical Endoscopy

, Volume 29, Issue 5, pp 1018–1023 | Cite as

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

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

Abstract

Background

Marginal ulceration after gastric bypass surgery is a recognized complication and has been reported in 1–16 % of patients. There is evidence that acidity may play a role in the disease pathophysiology and it is a common practice for bariatric surgeons to begin a prophylactic course of proton pump inhibitors (PPI), postoperatively.

Methods

MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched using the most comprehensive timeline for each database up to January 2012. Studies that included patients undergoing gastric bypass who received a prophylactic course of PPI postoperatively were eligible. Two reviewers independently selected trials and extracted data. The primary outcome was the incidence of marginal ulcers diagnosed on the basis of endoscopic findings. Inverse variance random effects models were used to estimate odds ratio (OR) and weighted proportion of ulcers. Odds ratio and weighted pooled proportion with corresponding 95 % confidence intervals (CI) are reported.

Results

The strategic search identified 167 citations. A total of seven studies involving 2,917 participants were eligible for inclusion and 2,114 were used for analysis. The weighted pooled proportion of ulcer formation in PPI groups including all seven studies (four single group cohort studies and PPI arm of three cohort studies) was 5.0 % [95 % CI 2–10 %] (N = 1,407). The OR of marginal ulcer formation comparing PPI to no PPI for three comparative cohort studies was 0.50 [95 % CI 0.28–0.90, p = 0.02] (N = 1,022) with low heterogeneity (I 2 = 12 %) showing that the PPI group significantly experienced twice less ulceration with PPI treatment compared to no PPI treatment.

Conclusion

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.

Keywords

Proton pump inhibitors PPI Bypass Obesity Ulcer Marginal 

Notes

Disclosures

Drs Wu Chao Ying, Kim, Khan, Farrokhyar, D’Souza, Gmora, Anvari and Hong have no conflicts of interest to disclose.

References

  1. 1.
    MacLean LD, Rhode BM, Nohr C, Katz S, McLean AP (1987) Stomal ulcer after gastric bypass. J Am Coll Surg 185:1–7CrossRefGoogle Scholar
  2. 2.
    Sapala JA, Wood MH, Sapala MA, Flake TM Jr (1998) Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 8:505–516CrossRefPubMedGoogle Scholar
  3. 3.
    Dallal RM, Bailey LA (2006) Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis 2:455CrossRefPubMedGoogle Scholar
  4. 4.
    Rasmussen JJ, Fuller W, Ali MR (2007) Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc 21:1090CrossRefPubMedGoogle Scholar
  5. 5.
    Heath D, McDougall K, Jones L, Pratik S (2010) A survey on the use of prophylaxis against venous thrombolembolic disease and peptic ulceration amongst members of the British Obesity and Metabolic Surgery Society (BOMSS). IFSO XV World Congress in Long Beach, Los Angeles, CaliforniaGoogle Scholar
  6. 6.
    Garrido AB Jr, Rossi M, Lima SE Jr, Brenner AS, Gomes CA Jr (2010) Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment: prospective multicentric study. Arq Gastroenterol 47(2):130–134CrossRefGoogle Scholar
  7. 7.
    Magee C, Brocklehurst JM, Weaver S, Macadam R, Javed S, Kerrigan D (2010) Marginal ulceration is a rare event following Laparoscopic Roux-En-Y Gastric Bypass (Lrygb). IFSO XV World Congress in Long Beach, Los Angeles, CaliforniaGoogle Scholar
  8. 8.
    Van Dessel E, Dillemans B, Van Cauwenberge S, De Cluwé L (2010) Prevention of marginal ulcers after Laparoscopic Roux-en-Y Gastric Bypass with omeprazole: is it worth the effort? Obes Surg 20:808–827CrossRefGoogle Scholar
  9. 9.
    D’Hondt MA, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F (2010) Can a short course of prophylactic low-dose proton pump inhibitor therapy prevent stomal ulceration after laparoscopic Roux-en-Y gastric bypass? Obes Surg 20(5):595–599CrossRefPubMedGoogle Scholar
  10. 10.
    Gumbs AA, Duffy AJ, Bell RL (2006) Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis 2(4):460–463CrossRefPubMedGoogle Scholar
  11. 11.
    Wilson JA, Romagnuolo J, Byrne TK, Morgan K, Wilson FA (2006) Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol 101(10):2194–2199CrossRefPubMedGoogle Scholar
  12. 12.
    Hedberg J, Hedenstrom H, Nilsson S, Sunbom M, Gustavsson S (2005) Role of gastric acid in stomal ulcer after gastric bypass. Obes Surg 15:1375–1378CrossRefPubMedGoogle Scholar
  13. 13.
    Schirmer B, Erenoglu C, Miller A (2002) Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass. Obes Surg 12:634–638CrossRefPubMedGoogle Scholar
  14. 14.
    Csendes A, Burgos AM, Altuve J, Bonacic S (2009) Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 19:135–138CrossRefPubMedGoogle Scholar
  15. 15.
    Wolfe MM (2014) Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders. In: Post TW (ed) UpToDate. UpToDate, Waltham, MA. (Accessed on February 17, 2014)Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Valerie Wu Chao Ying
    • 1
  • Song Hon H. Kim
    • 1
  • Khurram J. Khan
    • 2
  • Forough Farrokhyar
    • 3
  • Joanne D’Souza
    • 3
  • Scott Gmora
    • 1
  • Mehran Anvari
    • 1
  • Dennis Hong
    • 1
    • 4
  1. 1.General SurgeryMcMaster UniversityHamiltonCanada
  2. 2.GastroenterologyMcMaster UniversityHamiltonCanada
  3. 3.Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonCanada
  4. 4.St. Joseph’s HealthcareHamiltonCanada

Personalised recommendations