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Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis

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Journal of Gastrointestinal Surgery

Abstract

Introduction

Marginal ulcer (MU) is a common complication following Roux-en-Y gastric bypass (RYGB) with an incidence rate of up to 25%. Several studies have evaluated different risk factors associated with MU with inconsistent findings. In this meta-analysis, we aimed to identify the predictors of MU after RYGB.

Methods

A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through April 2022. All studies that used a multivariate model to assess risk factors for MU after RYGB were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies were obtained within a random-effects model.

Results

Fourteen studies with 344,829 patients who underwent RYGB were included. Eleven different risk factors were analyzed. Meta-analysis demonstrated that Helicobacter pylori (HP) infection (OR 4.97 [2.24–10.99]), smoking (OR 2.50 [1.76–3.54]), and diabetes mellitus (OR 1.80 [1.15–2.80]), were significant predictors of MU. Increased age, body mass index, female gender, obstructive sleep apnea, hypertension, and alcohol use were not predictors of MU. There was a trend of an increased risk of MU associated with nonsteroidal anti-inflammatory drugs (OR 2.43 [0.72–8.21]) and a lower risk of MU with proton pump inhibitors use (OR 0.44 [0.11–2.11]).

Conclusions

Smoking cessation, optimizing glycemic control, and eradication of HP infection reduce the risk of MU following RYGB. Recognition of predictors of MU after RYGB will allow physicians to identify high-risk patients, improve surgical outcomes, and reduce the risk of MU.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Azizullah Beran & Mohammad Al-Haddad

  2. Department of General Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA

    Mohammad Shaear

  3. Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA

    Saif Al-Mudares

  4. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Ishna Sharma, Marita Salame, Ray Portela & Omar M. Ghanem

  5. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Reem Matar & Barham K. Abu Dayyeh

  6. Department of Surgery, Texas Tech University, El Paso, TX, USA

    Benjamin Clapp

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Contributions

Study conception and design: Azizullah Beran, Barham K. Abu Dayyeh, and Omar M. Ghanem; collection and acquisition of data: Azizullah Beran, Mohammad Shaear, Reem Matar, and Saif Al-Mudares; analysis and interpretation of data: Azizullah Beran, Mohammad Shaear, Saif Al-Mudares, and Ray Portela; drafting and editing of manuscript: Azizullah Beran, Mohammad Shaear, Mohammad Al-Haddad, Ishna Sharma, and Marita Salame; critical revision: Marita Salame, Mohammad Al-Haddad, Benjamin Clapp, Barham K. Abu Dayyeh, and Omar M. Ghanem. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Omar M. Ghanem.

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Ethics approval and consent to participate

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

IRB approval

This study was deemed exempt by the Institutional Review Board.

Conflict of interest

Dr. Barham Abu Dayyeh has received consulting fee from the Endogenex, Endo-TAGSS, Metamodix, and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; speaker honorarium from Olympus, Johnson and Johnson; speaker honorarium and grant/research support from Medtronic, Endogastric solutions; and research support/grant from the Apollo Endosurgery, and Spatz Medical. All other authors (Azizullah Beran, Mohammad Shaear, Saif Al-Mudares, Ishna Sharma, Reem Matar, Mohammad Al-Haddad, Marita Salame, Ray Portela, Benjamin Clapp, and Omar M. Ghanem) do not have conflicts of interest to disclose.

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Beran, A., Shaear, M., Al-Mudares, S. et al. Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis. J Gastrointest Surg 27, 1066–1077 (2023). https://doi.org/10.1007/s11605-023-05619-7

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  • DOI: https://doi.org/10.1007/s11605-023-05619-7

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