title: Predictors of marginal ulcers after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a highly effective therapy for morbid obesity. As the most common postoperative complication, marginal ulcers (MU) present a significant disease burden. The etiology of marginal ulcers after gastric bypass has not been clearly defined. The purpose of this study was to identify independent risk factors for MU.
  
  
  METHODS
  We performed a retrospective study of a single surgeon's experience performing LRYGB between July 2001 and January 2006 in a United States private practice and university hospital. We investigated patient factors and comorbidities associated with the development of marginal ulcers. The five most common comorbidities were hypertension, type 2 diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, and obstructive sleep apnea. We analyzed these factors using multivariate logistic regression adjusting for demographics, BMI, and all comorbidities.
  
  
  RESULTS
  In our 763 patients, 89% were female, 84.7% were African-American, and the mean BMI was 50.2 kg/m(2) before surgery. Marginal ulcers occurred in 23 patients (3.01%) over a mean of 64 months. On χ(2) analysis, hypertension, gastroesophageal reflux disease, hyperlipidemia, and sleep apnea were significantly correlated with MU. On multivariate analysis, the odds of marginal ulcer formation were 7.84 among hypertensive patients with a 95% confidence interval of 1.75-35.06 (P = 0.007). Hypertension was the only significant predictor of marginal ulcer disease.
  
  
  CONCLUSIONS
  In our study, marginal ulcers occurred more frequently in patients with preoperative hypertension. At higher risk, these patients could be good candidates for extended acid suppression prophylaxis after LRYGB.
authors: Department of Surgery, Howard University College of Medicine, Washington, District of Columbia, USA. neil03@gmail.com
authors: Neil H
authors: NH
authors: Bhayani
authors: Tolulope A
authors: TA
authors: Oyetunji
authors: David C
authors: DC
authors: Chang
authors: Edward E
authors: EE
authors: Cornwell
authors: Gezzer
authors: G
authors: Ortega
authors: Terrence M
authors: TM
authors: Fullum
mesh_terms: D000328:Adult; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors