title: Variation in utilization of acid-reducing medication at 1 year following bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.
abstract: BACKGROUND
  Morbidly obese patients undergoing bariatric surgery have high rates of gastroesophageal reflux and are often treated with acid-reducing medications (ARM) such as proton pump inhibitors or H2-blockers. The objective of this study was to evaluate the effect of bariatric procedures on the utilization of ARM. We analyzed data from the clinical registry of the Michigan Bariatric Surgery Collaborative on 35,477 patients undergoing bariatric surgery between January 2006 and October 2012 who completed both baseline and 1-year follow-up surveys. Procedures included laparoscopic adjustable gastric banding (LAGB, n=2,627), Roux-en-Y gastric bypass (RYGB, n=6,410), sleeve gastrectomy (SG, n=1,567), and biliopancreatic diversion with duodenal switch (BPD/DS, n=162).
  
  
  METHODS
  Rates of ARM at 1 year by procedure type were compared using logistic regression analysis. Models were adjusted for patient characteristics, baseline co-morbidities, weight loss, and hiatal hernia repair.
  
  
  RESULTS
  Overall ARM use at baseline was 37.7% and declined to 29.6% at 1 year after bariatric surgery. The proportion of patients starting an ARM at 1 year when they were not using one at baseline by procedure was LAGB (13.9%), RYGB (19.2%), SG (21.6%), and BPD/DS (26.7%). The proportion of patients discontinuing an ARM at 1 year when they were using one at baseline by procedure was LAGB (55.6%), RYGB (56.2%), SG (37.3%), and BPD/DS (42.1%). Compared with LAGB on multivariable analysis, the likelihood of ARM use at 1 year was higher for SG (OR 1.70, 95% CI 1.45-1.99) and BDP/DS (OR 1.53, CI .97-2.40) but not different for RYGB (OR 1.02, CI .90-1.16).
  
  
  CONCLUSIONS
  Overall ARM use decreases after bariatric surgery; however, it is not uniform and depends on procedure type. SG is a significant predictor for ARM use at 1 year.
authors: Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: ovarban@med.umich.edu.
authors: Oliver A
authors: OA
authors: Varban
authors: Department of Surgery, St. John Providence Health System, St. Clair Shores, Michigan.
authors: Abdelkader A
authors: AA
authors: Hawasli
authors: Department of Surgery, Henry Ford Health System, Detroit, Michigan.
authors: Arthur M
authors: AM
authors: Carlin
authors: Department of Surgery, Henry Ford Health System, Detroit, Michigan.
authors: Jeffrey A
authors: JA
authors: Genaw
authors: Department of Surgery, Marquette General Hospital, Marquette, Michigan.
authors: Wayne
authors: W
authors: English
authors: Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Justin B
authors: JB
authors: Dimick
authors: Department of Surgery, Detroit Medical Center, Detroit, Michigan.
authors: Michael H
authors: MH
authors: Wood
authors: Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: John D
authors: JD
authors: Birkmeyer
authors: Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Nancy J O
authors: NJ
authors: Birkmeyer
authors: Value Partnerships Program, Blue Cross and Blue Shield of Michigan, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Jonathan F
authors: JF
authors: Finks
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Adjustable gastric band; Antireflux medication; Bariatric surgery; Duodenal switch; Gastric bypass; Gastroesophageal reflux; Sleeve gastrectomy