PPI Use Likely Increases After Bariatric Surgery

A recent study showed that patients with obesity and gastroesophageal reflux disease (GERD) who receive a sleeve gastrectomy (SG) are more likely to continue proton pump inhibitor (PPI) therapy 4 years after surgery, compared with patients who had undergone gastric bypass (GBP).

Other risk factors that contribute to continued PPI use 4 years after surgery are higher body mass index (BMI) and preoperative antidepressant treatment.

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PPIs are commonly used to treat GERD, which often accompanies obesity. However, several concerns exist regarding the risk of de novo GERD or exacerbation of preexisting GERD after SG with PPI use.

In their study, the researchers evaluated 8250 patients with obesity who had undergone GBP and 11,923 who had undergone SG in 2011. Patient data was obtained via the French National Health Insurance database. Participants were considered to be on continuous PPI therapy if PPIs were prescribed 6 or more times per year.

Logistic regression models were used to determine odds ratios for potential risk factors for PPI reimbursement 4 years after surgery.

Results indicated that overall, continuous use of PPIs increased from baseline to 4 years in both GBP and SG patients. However, SG patients were more likely to continue PPI therapy 4 years after surgery compared with GBP patients, with use increasing from 10.9% to 26.5% in SG patients and from 11.4% to 21.9% in GPB patients.

Multivariate analyses showed that the major risk factors for persistent continuous PPI treatment 4 years after surgery also included higher BMI and preoperative antidepressant treatment.

“At a nationwide scale, continuous PPI treatment is used by 1 of 10 obese patients before bariatric surgery, but by 1 of 4 patients 4 years after surgery,” the researchers concluded. “SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.”

—Christina Vogt

Reference:

Thereaux J, Lesuffleur T, Czernichow S, et al. Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort. Surg Obes Related Dis. 2017;13(6):951-959. doi:10.1016/j.soard.2016.12.013.