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Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass: A national survey of surgeon practices

Published:October 10, 2022DOI:https://doi.org/10.1016/j.soard.2022.10.002

      Highlights

      • Most surgeons (85.4%) administered prophylactic proton pump inhibitors (PPIs) to their Roux-en-Y gastric bypass (RYGB) patients
      • Pantoprazole was the most common type of PPI prophylaxis during hospitalization
      • Omeprazole was the most common type of PPI prophylaxis postdischarge
      • The duration of PPI use varied based on the presence of preoperative reflux

      Abstract

      Background

      Proton pump inhibitors (PPIs) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear.

      Objectives

      Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis.

      Setting

      Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited centers.

      Methods

      Members of the American Society for Metabolic and Bariatric Surgery research committee developed and administered a web-based anonymous survey in November 2021 to bariatric surgeons of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited programs detailing questions related to surgeons’ use of PPI after RYGB including patient selection, medication, dosage, and treatment duration.

      Results

      The survey was completed by 112 surgeons (response rate: 52.6%). PPIs were prescribed by 85.4% of surgeons for all patients during their hospitalization, 3.9% for selective patients, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used during hospitalization (38.5%), while omeprazole was most prescribed (61.7%) after discharge. The duration of postoperative PPI administration varied; it was 3 months in 43.6%, 1 month in 20.2%, and 6 months in 18.6% of patients. Finally, surgeons’ practice setting and case volume were not associated with the duration of prophylactic PPI administration after RYGB.

      Conclusions

      PPI administration practices vary widely among surgeons after RYGB, which may be related to the limited comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after RYGB to maximize clinical benefit.

      Keywords

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