title: Do sleeve gastrectomy and gastric bypass influence treatment with proton pump inhibitors 4 years after surgery? A nationwide cohort.
abstract: BACKGROUND
  Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG).
  
  
  OBJECTIVE
  To assess PPI use at 4 years after bariatric surgery.
  
  
  METHODS
  French National Health Insurance.
  
  
  METHODS
  Data were extracted from the French National Health Insurance database. All adult obese patients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery.
  
  
  RESULTS
  Overall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55-2.25), higher body mass index (OR 1.85; 95% CI 1.35-2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56-2.29).
  
  
  CONCLUSIONS
  At a nationwide scale, continuous PPI treatment is used by 1 of 10 obese patients before bariatric surgery, but by 1 of 4 patients 4 years after surgery. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.
authors.affiliation: Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France; University of Bretagne Occidentale, EA 3878 Brest, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.affiliation: Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lesuffleur
authors.affiliation: Department of Nutrition, Hôpital Européen-Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiological Cohort in Population, Villejuif, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.affiliation: Institute of Cardiometabolism and Nutrition, Heart and Nutrition Department, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Basdevant
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.affiliation: Department of Digestive Surgery, CHU de Montpellier, Montpellier, France.
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.affiliation: Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Millat
authors.affiliation: Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France. Electronic address: anne.fagot@cnamts.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastric bypass; Gastroesophageal reflux disease; Proton pump inhibitor; Sleeve gastrectomy