Prophylactic PPI help reduce marginal ulcers after gastric bypass surgery: a systematic review and meta-analysis of cohort studies
Abstract
Background Marginal ulceration after gastric bypass surgery is a recognized complication and has been reported in 1-16% of patients. There is evidence that acidity may play a role in the disease pathophysiology and it is a common practice for bariatric surgeons to begin a prophylactic course of proton pump inhibitors (PPI), postoperatively.Methods MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched using the most comprehensive timeline for each database up to January 2012. Studies that included patients undergoing gastric bypass who received a prophylactic course of PPI postoperatively were eligible. Two reviewers independently selected trials and extracted data. The primary outcome was the incidence of marginal ulcers diagnosed on the basis of endoscopic findings. Inverse variance random effects models were used to estimate odds ratio (OR) and weighted proportion of ulcers. Odds ratio and weighted pooled proportion with corresponding 95% confidence intervals (CI) are reported.Results The strategic search identified 167 citations. A total of seven studies involving 2,917 participants were eligible for inclusion and 2,114 were used for analysis. The weighted pooled proportion of ulcer formation in PPI groups including all seven studies (four single group cohort studies and PPI arm of three cohort studies) was 5.0% [95% CI 2-10%] (N = 1,407). The OR of marginal ulcer formation comparing PPI to no PPI for three comparative cohort studies was 0.50 [95% CI 0.28-0.90, p = 0.02] (N = 1,022) with low heterogeneity (I(2) = 12%) showing that the PPI group significantly experienced twice less ulceration with PPI treatment compared to no PPI treatment.Conclusion This finding suggests a significant incremental benefit of prophylactic PPI in reducing marginal ulcer after gastric bypass surgery. Prospective randomized trials are needed to further define the role of PPI following gastric bypass surgery.
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A meta-analysis of three cohort studies suggested a beneficial effect of PPI treatment on marginal ulcers after bypass procedures (OR 0.50, 95% CI 0.29 to 0.90, moderate certainty).
“A meta-analysis of three cohort studies that compared the comparative effect of PPIs on marginal ulcers suggested beneficial effect of PPI treatment (OR 0.50, 95% CI 0.29 to 0.90, moderate certainty) (Supplementary Table S34) [131].”
From Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP (2020) · cites this paper as [131]
Cites
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Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.10.025 · Cited by 608 · see citing works
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Di Lorenzo, N., Antoniou, S. A., Batterham, R. L., Busetto, L., Godoroja, D., Iossa, A., Carrano, F. M., Agresta, F., Alarçon, I., Azran, C., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07555-y · Cited by 465 · see citing works
Bennett, S., Gostimir, M., Shorr, R., Mallick, R., Mamazza, J., & Neville, A. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.04.012 · Cited by 111 · see citing works
Obesity: pathophysiology and therapeutic interventions
Kong, Y., Yang, H., Nie, R., Zhang, X., Zuo, F., Zhang, H., & Nian, X. (2025) · Molecular Biomedicine · doi:10.1186/s43556-025-00264-9 · Cited by 89 · see citing works
- Authors
- Wu Chao Ying, V., H. Kim, S. H., J. Khan, K., Farrokhyar, F., D’Souza, J., Gmora, S., Anvari, M., & Hong, D.
- Affiliations
- McMaster University (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- Corresponding author
- Hong, Dennis
- Venue
- Surgical Endoscopy
- Published
- 2014-08-27
- Volume
- 29
- Issue
- 5
- Pages
- 1018-1023
- ISSN
- 0930-2794 (ISSN-L)
- 1432-2218
- OpenAlex
- W2053529571
- Cited by
- 111
- References
- 12
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 15 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 17 · 2019: 5 · 2018: 10 · 2017: 3 · 2016: 13 · 2015: 5
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Surgical Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- proton pump inhibitors, marginal ulcer, gastric bypass, bariatric surgery, postoperative complications, prophylaxis, gastric acid secretion, endoscopic findings
- MeSH terms
- Follow-Up Studies, Humans, Peptic Ulcer, Postoperative Complications, Gastric Bypass, Proton Pump Inhibitors
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