title: Acid suppression medications are associated with suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass in patients older than 40 years.
abstract: BACKGROUND
  Bariatric surgery, including laparoscopic Roux-en-Y gastric bypass (LRYGB), achieves the greatest long-term weight loss in severe obesity. Approximately 50%-60% of severely obese patients have gastroesophageal reflux disease, and a substantial proportion is taking a proton pump inhibitor (PPI) or histamine-2 blocker (H2 B) at the time of LRYGB. The objective of this study was to explore the association of PPI/H2 B use before LRYGB with suboptimal percent weight loss (PWL) after LRYGB.
  
  
  METHODS
  This was a cohort study of 472 consecutive patients who underwent LRYGB at a single center from 2004-2011. Suboptimal PWL was defined as<14% at 2 months,<25% at 6 months, and<30% at 12 months. Because of effect modification by age, stratified analyses (by median age of 40 yr) were performed. All models were adjusted for appropriate covariates, including obesity-associated co-morbidities.
  
  
  RESULTS
  For patients aged ≤40 years, PPI/H2 B use leading up to LRYGB was not associated with suboptimal PWL at 2 months (P = .86), 6 months (P = .47), or 12 months (P = .66). However, for patients aged>40 years, PPI/H2 B use leading up to LRYGB was associated with a nonsignificant increase in suboptimal PWL at 2 months (odds ratio [OR] 2.23; P = .08) and significant increases in suboptimal PWL at 6 months (OR 7.23; P = .002) and 12 months (OR 11.1; P = .02). Results were independent of GERD.
  
  
  CONCLUSIONS
  Mechanisms for the poorer weight loss in patients aged>40 years who were using a PPI/H2 B just before LRYGB should be explored.
authors.affiliation: Division of Gastroenterology & Hepatology, University of Colorado Denver, Aurora, Colorado.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Ward
authors.affiliation: Department of Medicine, University of Colorado Denver, Aurora, Colorado.
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Jensen-Otsu
authors.affiliation: Division of Gastrointestinal, Tumor and Endocrine Surgery, University of Colorado Denver, Aurora, Colorado.
authors.forename: Jonathon A
authors.initials: JA
authors.lastname: Schoen
authors.affiliation: Division of Gastrointestinal, Tumor and Endocrine Surgery, University of Colorado Denver, Aurora, Colorado.
authors.forename: Kevin
authors.initials: K
authors.lastname: Rothchild
authors.affiliation: Division of Gastrointestinal, Tumor and Endocrine Surgery, University of Colorado Denver, Aurora, Colorado.
authors.forename: Breana
authors.initials: B
authors.lastname: Mitchell
authors.affiliation: Division of Gastroenterology & Hepatology, University of Colorado Denver, Aurora, Colorado. Electronic address: Gregory.austin@ucdenver.edu.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D015431:Weight Loss
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastroesophageal reflux disease; Histamine 2 blocker; Proton pump inhibitor; Roux-en-Y gastric bypass; Weight loss