Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort

• Published in: Surgery for obesity and related diseases Vol. 13; no. 6; pp. 951 - 959
• Main Authors: Thereaux, Jérémie, Lesuffleur, Thomas, Czernichow, Sébastien, Basdevant, Arnaud, Msika, Simon, Nocca, David, Millat, Bertrand, Fagot-Campagna, Anne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017; Elsevier
• Subjects: Adult; Aged; Bariatric Surgery - methods; Female; Gastrectomy - methods; Gastric bypass; Gastric Bypass - methods; Gastroenterology and Hepatology; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - etiology; Gastroesophageal reflux disease; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - surgery; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Proton pump inhibitor; Proton Pump Inhibitors - therapeutic use; Sleeve gastrectomy; Surgery; Young Adult; Gastroesophageal reflux disease; Gastric bypass; Sleeve gastrectomy; Proton pump inhibitor
• ISSN: 1550-7289; 1878-7533; 1878-7533
• DOI: 10.1016/j.soard.2016.12.013

Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). To assess PPI use at 4 years after bariatric surgery. French National Health Insurance. Data were extracted from the French National Health Insurance database. All adult obese patients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery. Overall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55–2.25), higher body mass index (OR 1.85; 95% CI 1.35–2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56–2.29). 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. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.