Use of Acid Suppressive Therapy Following Gastric Bypass and Sleeve Gastrectomy at Long-Term Follow-Up

Background: Earlier studies demonstrate that increased gastroesophageal reflux disease (GERD) symptoms following sleeve gastrectomy (SG) may necessitate initiation or dose escalation of acid suppressive therapy (AST). The relationship between GERD and AST use following Roux-en-Y gastric bypass (RYGB) is less clear.Methods: This is a retrospective study of patients undergoing primary SG or RYGB at tertiary care hospital from 2004 to 2014. Inclusion criteria were patients older than 18 years of age with employee health insurance at the study institution and at least 3 years of follow-up. The use of AST, defined as either proton pump inhibitor or selective H-2 blockers, was compared pre- and postoperatively.Results: A total of 356 patients were identified, including 104 (29.2%) who has SG and 252 who had RYGB (70.8%). Similar proportions of patients had GERD before SG (54.8%) and RYGB (49.6%, p = 0.37). Long-term outcomes were compared at a median follow-up time period of 164 months (IQR, 119-215). The proportion of patients using AST increased following RYGB (21.0% preop vs. 34.1% postop, p < 0.05) including 54 (21.4%) patients with de novo postoperative use. Following SG, the proportion of patients using AST increased from 19.2% to 38.5% (p < 0.05), including 28 (26.9%) patients with de novo use. Similar proportions of patients were using AST following RYGB and SG (p > 0.05).Conclusion: This study confirms prior evidence of SG as a potentially refluxogenic operation, with many patients needing AST at long-term follow-up. However, it also demonstrates a similar proportion of patients requiring AST following RYGB. Although the current study is unable to delineate the reasons for this, prospective investigation into AST use after RYGB is warranted.