Effect of long-term proton pump inhibitor therapy on hemoglobin and serum iron levels after sleeve gastrectomy


      • 1.
        Iron deficiency anemia (IDA) and iron deficiency (ID) has been studied at depth for Roux En Y gastric bypass, and to some extent in sleeve gastrectomy patients.
      • 2.
        Gastro-esophageal reflux disease (GERD) is commonly associated with sleeve resections and warrants post-operative acid reducing therapy.
      • 3.
        This is a single institution case control study. Comparing preoperative and post-operative hemoglobin and serum iron levels in those patients still taking PPIs to those not taking PPIs at 12 months.
      • 4.
        We have not found any other study focusing this issue in bariatric population.
      • 5.
        Our study indicates that PPIs can increase the severity of post-operative iron deficiency and iron deficiency anemia in patients who underwent LSG.
      • 6.
        Aggressive surveillance is needed in those taking long-term PPIs after LSG and we encourage to discontinue PPIs as clinically appropriate.
      • 7.
        It is encouraged to further analyze these findings in a larger randomized study model.



      Iron deficiency anemia and iron deficiency are commonly seen after bariatric surgery. Gastroesophageal reflux disease is commonly associated with sleeve resections and warrants postoperative acid reducing therapy.


      To analyze the impact of long-term proton pump inhibitors on iron deficiency or iron deficiency anemia in laparoscopic sleeve gastrectomy (LSG) patients.


      University hospital, USA.


      A single-institution case control study included 2 groups of bariatric patients who underwent LSG. Patient characteristics such as age, sex, American Society of Anesthesiologists risk, body mass index, nutritional status, and co-morbidities were comparable. Postoperative follow-up was scheduled at 1-week, and 1-, 3-, 6-, and 12-month durations. All received standard postoperative iron, multivitamin therapy, and nutritional screening and evaluation. All patients were placed on postoperative proton pump inhibitors (PPI) therapy for at least 3 months. At third postoperative visit, anemia indicators were assessed by serum iron concentration, total iron binding capacity, transferrin saturation, red blood cell count, hemoglobin concentration, mean corpuscular volume, and mean corpuscular hemoglobin concentration. Postoperative hemoglobin and serum iron levels were compared between those patients still taking PPIs to those not taking PPIs at 12 months.


      A total of 287 patients underwent LSG from January 2016 to December 2017, 203 were included and 84 patients were excluded. Patients taking long-term PPIs (>12 mo, n = 85) were compared with those not taking PPIs (n = 118) and outcomes were respectively as follows: mean pre- and postoperative hemoglobin levels (in g/DL) were 13.2 and 10.7, and 13.3 and 13.7; mean postoperative serum iron levels (in μg/DL) were 41.7 and 88.7. Results were computed using paired t test and odds ratio that showed iron deficiency anemia in 12.9% (11/85) in PPI group compared with 4.23% (5/118) in the non-PPI group (odds ratio of 3.3, 95% confidence interval [1.21–10], and P = .03). Iron deficiency was seen in 22.3% (19/85) in the PPI group and 11% (13/118) in the non-PPI group (odds ratio of 2.3, 95% confidence interval [1.07–5.02] and P = .031).


      Our study indicates that PPIs can increase the severity of iron deficiency and iron deficiency anemia in patients who underwent LSG. Aggressive surveillance is needed in those taking long-term PPIs after LSG. It is encouraged to further analyze these findings in a larger randomized study model design.

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