Abstract
Purpose
Roux-en-Y gastric bypass (RYGB) is one of the bariatric surgeries most frequently performed worldwide. Since this operation may predispose to the formation of peptic ulcer of the gastrojejunal anastomosis, the use of proton pump inhibitors (PPI) is recommended during the first postoperative year. However, so far, there is no detailed knowledge about the absorption of this medication during the immediate postoperative period and consequently about its effectiveness in blocking acid secretion. The objective was to assess the possible endoscopic peptic changes, the absorption of omeprazole (OME), and the status of fasting gastrinemia before and after RYGB operation.
Materials and Methods
OME absorption, the production of its metabolites omeprazole sulfone (OMES) and 5-hydroxyomeprazole (HOME), and basal (fasting) gastrinemia were determined in patients submitted to RYGB before and 2 months after the operation. Upper digestive endoscopy (UDE) was also performed before and 6 months after the operation.
Results
Twenty patients were studied. Preoperatively, all these patients had some peptic changes and 55% tested positive for Helicobacter pylori. Six months after surgery, ten patients still showed endoscopic changes and one patient tested positive for H. pylori. During the postoperative period, there was a reduction of OME absorption and of the production of its metabolites 90 min after administration of the drug, and reduction of serum gastrin levels.
Conclusion
The standard OME dose (40 mg) administered after bariatric surgery is insufficient to achieve serum levels that can effectively block the production of hydrochloric acid, permitting the formation of peptic injuries in many patients.
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Change history
18 October 2017
Larissa Alves dos Reis Dias wasmistakenly included in the 13 acknowledgment section of this article, and was mistakenly.
24 August 2017
An erratum to this article has been published.
References
Vedana EHB, Peres MA, Das Neves J, et al. Prevalência de obesidade e fatores potencialmente causais em adultos na região sul do Brasil. Arq Bras Endocrinol Metabol. 2008;52(7):1156–11.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
Sunyer XP. The metabolic syndrome: how to approach differing definitions. Med Clin North Am. 2007;91(6):1025–40.
WHO (World Health Organization). Obesity: preventing and managing the global epidemic of obesity. Geneva, 2004.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
Bult MJF, Van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158(2):135–45.
Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010;11(1):41–50.
Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8(5):505–16.
Wu CYV, Kim SH, Kam KJ, et al. Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies. Surg Endosc. 2014;29(5):1018–23.
Schubert ML. Gastric secretion (review). Curr Opin Gastroenterol. 2010;26(6):598–603.
Bennett S, Gostimir M, Shorr R, et al. The role of routine preoperative upper endoscopy in bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;16:1–10.
Garrido Jr AB, Rossi M, Lima Jr SE, et al. Early marginal ulcer following Roux-en-Y gastric bypass under proton pump inhibitor treatment—prospective multicentric study. Arq Gastroenterol. 2010;47(2):130–4.
Borovicka J, Krieger-Grübell C, Van Der Weg B, et al. Effect of morbid obesity, gastric banding and gastric bypass on esophageal symptoms, mucosa and function. Surg Endosc. 2017;31(2):552–60.
Czeczko LEA, Cruz MA, Klostermann FC, et al. Correlação entre a endoscopia digestiva alta pré e pós-operatória em pacientes submetidos ao bypass gastrojejunal em Y-de-Roux. ABCD Arq Bras Cir Dig. 2016;29(1):33–7.
Darwich AD, Henderson K, Burgin A, et al. Trends in oral drug bioavailability following bariatric surgery: examining the variable extent impact on exposure of different drug classes. Br J Ciln Pharmacol. 2012;74(5):774–87.
Roerig JL, Steffen KJ, Zimmerman C, et al. A comparison of duloxetine plasma levels in postbariatric surgery patients versus matched nonsurgical control subjects. J Clin Psychopharmacol. 2013;33(4):479–84.
Tandra S, Chalasani N, Jones DR, et al. Pharmacokinetic and pharmacodynamic alterations in the Roux-en-Y gastric bypass recipients. Ann Surg. 2013;258:262–9.
Jacobsen SH, Olesen SC, Dirksen C, et al. Changes in gastrointestinal hormone response, insulin sensitivity, and beta-cell function within 2 weeks after gastric bypass in non-diabetic subjects. Obes Surg. 2012 Feb 23;22(7):1084–96.
Safatle-Ribeiro AV, Petersen PA, Pereira Filho DS, et al. Epithelial cell turnover is increased in the exclused stomach mucosa after Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2013;23(10):1616–23.
Meek CL, Lewis HB, Reimann F, et al. The effect of bariatric surgery on gastrointestinal and pancreatic peptides hormones. Peptides. 2016;77:28–37.
Schubert ML. Functional anatomy and physiology of gastric secretion. Curr Opin Gastroenterol. 2015;31(6):479–85.
Lamberts R, Brunner G, Solcia E. Effects of very long (up to 10 years) proton pump blocked on human gastric mucosa. Digestion. 2001;64:205–13.
Acknowledgments
Larissa Alves dos Reis is gratefully acknowledged.
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All procedures performed in studies involving human participants were in accordance and approved by the Research Ethics Committee of the HCFMRP-USP and also by the National Health Council, and Ethics in Research National Committee of the Brazilian Health Ministry, with the ethical standards and respecting the 1964 Helsinki declaration and its later amendments.
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Informed consent was obtained from all individual participants included in the study.
Financial Support
The financial support received was from FAEPA—Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo and Fundação Waldemar Barnsley Pessoa, Hospital São Francisco Ribeirão Preto, SP.
Additional information
A correction to this article is available online at https://doi.org/10.1007/s11695-017-2956-3.
An erratum to this article is available at https://doi.org/10.1007/s11695-017-2910-4.
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Collares-Pelizaro, R.V.A., Santos, J.S., Nonino, C.B. et al. Omeprazole Absorption and Fasting Gastrinemia After Roux-en-Y Gastric Bypass. OBES SURG 27, 2303–2307 (2017). https://doi.org/10.1007/s11695-017-2672-z
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DOI: https://doi.org/10.1007/s11695-017-2672-z