Collares-Pelizaro Renata V A, Santos José S, Nonino Carla B, dos Reis Dias Larissa Alves, Gaitani Cristiane M, Salgado Wilson
Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
Department of Clinical Analysis, Toxicology and Bromatology, Faculty of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, Brazil.
Obes Surg. 2017 Sep;27(9):2303-2307. doi: 10.1007/s11695-017-2672-z.
Roux-en-Y gastric bypass (RYGB) is one of the bariatric surgeries most frequently performed worldwide. Since this operation may predispose to the formation of peptic ulcer of the gastrojejunal anastomosis, the use of proton pump inhibitors (PPI) is recommended during the first postoperative year. However, so far, there is no detailed knowledge about the absorption of this medication during the immediate postoperative period and consequently about its effectiveness in blocking acid secretion. The objective was to assess the possible endoscopic peptic changes, the absorption of omeprazole (OME), and the status of fasting gastrinemia before and after RYGB operation.
OME absorption, the production of its metabolites omeprazole sulfone (OMES) and 5-hydroxyomeprazole (HOME), and basal (fasting) gastrinemia were determined in patients submitted to RYGB before and 2 months after the operation. Upper digestive endoscopy (UDE) was also performed before and 6 months after the operation.
Twenty patients were studied. Preoperatively, all these patients had some peptic changes and 55% tested positive for Helicobacter pylori. Six months after surgery, ten patients still showed endoscopic changes and one patient tested positive for H. pylori. During the postoperative period, there was a reduction of OME absorption and of the production of its metabolites 90 min after administration of the drug, and reduction of serum gastrin levels.
The standard OME dose (40 mg) administered after bariatric surgery is insufficient to achieve serum levels that can effectively block the production of hydrochloric acid, permitting the formation of peptic injuries in many patients.
Roux-en-Y胃旁路术（RYGB）是全球最常开展的减肥手术之一。由于该手术可能易引发胃空肠吻合口消化性溃疡的形成，因此建议在术后第一年使用质子泵抑制剂（PPI）。然而，迄今为止，对于术后即刻该药物的吸收情况以及其抑制胃酸分泌的效果，尚无详细了解。本研究旨在评估RYGB手术前后内镜下可能出现的消化性改变、奥美拉唑（OME）的吸收情况以及空腹胃泌素血症状态。
对接受RYGB手术的患者，在术前及术后2个月测定OME的吸收情况、其代谢产物奥美拉唑砜（OMES）和5-羟基奥美拉唑（HOME）的生成情况以及基础（空腹）胃泌素血症水平。同时在术前及术后6个月进行上消化道内镜检查（UDE）。
共研究了20例患者。术前，所有这些患者均有一些消化性改变，55%的患者幽门螺杆菌检测呈阳性。术后6个月，10例患者仍有内镜下改变，1例患者幽门螺杆菌检测呈阳性。术后期间，给药90分钟后，OME的吸收及其代谢产物的生成减少，血清胃泌素水平降低。
减肥手术后给予标准剂量的OME（40mg）不足以达到能有效抑制盐酸生成的血清水平，从而导致许多患者出现消化性损伤。
