title: A comparison of 30-day versus 90-day proton pump inhibitor therapy in prevention of marginal ulcers after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Marginal ulceration is one of the most common complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Proton pump inhibitors (PPIs) are commonly administered to decrease the incidence of marginal ulcer development.
  
  
  OBJECTIVE
  We examine the differential impact of employing a 30-day versus 90-day postoperative PPI regimen on the development of marginal ulceration after LRYGB.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A retrospective cohort design was used to study all patients undergoing LRYGB at a single, high-volume bariatric center in Hamilton, Ontario, Canada. Three years previously, the duration of postoperative PPI administration was increased at our center from 30 to 90 days. Diagnosis of marginal ulceration was confirmed by upper endoscopy in patients presenting with epigastric pain and a clinical history suggestive of marginal ulceration. A χ(2) test of independence was performed to examine incidence of marginal ulceration and PPI duration.
  
  
  RESULTS
  A total of 1016 patients underwent LRYGB at our center between January 2009 and January 2013. No differences in baseline characteristics were observed between groups. Of the 1016 patients followed, 614 received 30 days of PPI therapy and 402 received 90 days of PPI therapy. The incidence of marginal ulceration after LRYGB decreased significantly (P<.05) among patients receiving daily PPI for 90 days (n = 26, 6.5%) compared with those receiving PPI for 30 days (n = 76, 12.4%).
  
  
  CONCLUSIONS
  This study suggests a significant benefit to longer duration prophylactic PPI administration after gastric bypass surgery to minimize the risk of symptomatic marginal ulceration.
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada.
authors.forename: Xian
authors.initials: X
authors.lastname: Kang
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Zurita-Macias
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hong
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada.
authors.forename: Margherita
authors.initials: M
authors.lastname: Cadeddu
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada.
authors.forename: Mehran
authors.initials: M
authors.lastname: Anvari
authors.affiliation: St Joseph's Healthcare Hamilton Department of Surgery, Hamilton, Ontario, Canada; McMaster University Department of Surgery, Hamilton, Ontario, Canada. Electronic address: gmora@mcmaster.ca.
authors.forename: Scott
authors.initials: S
authors.lastname: Gmora
mesh_terms: D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D010437:Peptic Ulcer / Q000175:diagnosis / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors
keywords: Bariatric surgery; LRYGB; Marginal ulceration; PPI; Proton pump inhibitors