Proton pump inhibitor prophylaxis after Roux-en-Y gastric bypass: A national survey of surgeon practices

Background: Proton pump inhibitors (PPIs) are frequently used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer development is unclear. Objectives: Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis. Setting: Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited centers. Methods: Members of the American Society for Metabolic and Bariatric Surgery research committee developed and administered a web-based anonymous survey in November 2021 to bariatric surgeons of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Programaccredited programs detailing questions related to surgeons' use of PPI after RYGB including patient selection, medication, dosage, and treatment duration. Results: The survey was completed by 112 surgeons (response rate: 52.6%). PPIs were prescribed by 85.4% of surgeons for all patients during their hospitalization, 3.9% for selective patients, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used during hospitalization (38.5%), while omeprazole was most prescribed (61.7%) after discharge. The duration of postoperative PPI administration varied; it was 3 months in 43.6%, 1 month in 20.2%, and 6 months in 18.6% of patients. Finally, surgeons' practice setting and case volume were not associated with the duration of prophylactic PPI administration after RYGB. Conclusions: PPI administration practices vary widely among surgeons after RYGB, which may be related to the limited comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after RYGB to maximize clinical benefit. (Surg Obes Relat Dis 2023;19:303-308.) (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

Background: Proton pump inhibitors (PPIs) are commonly used after Roux-en-Y gastric bypass (RYGB) to prevent marginal ulceration. However, the optimal duration of PPI treatment after surgery is unclear. Objective: To assess the practice variability of bariatric surgeons regarding postoperative PPI prophylaxis. Results: The survey showed that PPI administration practices widely varied among surgeons, with different patient selection, medication, dosage, and treatment duration. The study highlights the need for large clinical trials to define optimal practices for PPI prophylaxis after RYGB.