title: The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study.
abstract: BACKGROUND
  Marginal ulceration at the gastrojejunostomy is a serious complication after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) and occurs in 1%-16% of patients. Proton pump inhibitors (PPIs) might lower the occurrence of these ulcers.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate the effect of 6 months prophylactic usage of PPIs on the development of marginal ulceration and compare this with a historic patient control group.
  
  
  METHODS
  A single institution cohort at a bariatric center of excellence, The Sint Lucas Andreas Zienkenhuis, Amsterdam
  
  
  METHODS
  A consecutive database of patients who underwent LRYGB from November 2007 to September 2012 in a single institution was retrospectively reviewed. From August 2011, patients received a standard dose of pantozol 40 mg once daily directly postoperatively for 6 months. No standard PPI prophylaxis was administered before August 2011, and the patients not using PPIs in this historic cohort served as the control group.
  
  
  RESULTS
  A total of 610 patients underwent LRYGB, of which 128 patients (21.0%) underwent revisional surgery. Postoperative PPIs were administered in the intervention group of 337 patients, compared with the historic control group consisting of 273 patients. Six patients (1.2%) who received postoperative PPIs versus 20 patients (7.3 %) in the historic control group developed marginal ulceration (P = .001). Patients using proton pump inhibitors developed fewer gastrointestinal complaints postoperatively (P< .001).
  
  
  CONCLUSIONS
  Routine usage of PPIs reduced the occurrence of marginal ulceration after LRYGB.
authors.affiliation: Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands. Electronic address: usha.coblijn@gmail.com.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Coblijn
authors.affiliation: Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands.
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Steve M M
authors.initials: SM
authors.lastname: de Castro
authors.affiliation: Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, Amsterdam.
authors.forename: Sjoerd D
authors.initials: SD
authors.lastname: Kuiken
authors.affiliation: Department of Surgery, Sint Lucas Andreas Zienkenhuis Amsterdam, The Netherlands.
authors.forename: Willem F
authors.initials: WF
authors.lastname: van Tets
authors.affiliation: Department of Surgery, Sint Lucas Andreas Zienkenhuis Amsterdam, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: van Wagensveld
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Bariatric surgery; Gastric bypass; Gastric ulcer; Marginal ulcer; Prevention; Prophylactic; Proton pump inhibitors; RYGB; Roux-en-Y gastric bypass; Stomal ulcer; Ulceration