Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Surg Obes Relat Dis. 2022 Aug;18(8):1033-1041. doi: 10.1016/j.soard.2022.04.016. Epub 2022 Apr 22.
Gastroesophageal reflux (GERD) is common among patients with obesity who undergo bariatric surgery. Although gastric bypass and sleeve gastrectomy are the most common bariatric operations performed in the United States, their long-term comparative effectiveness on GERD medication use is unknown.
To compare the long-term effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication.
National cohort undergoing inpatient bariatric surgery.
This is a retrospective study of Medicare beneficiaries undergoing gastric bypass and sleeve gastrectomy between January 1, 2012, and December 31, 2017. A difference-in-differences analysis was conducted to evaluate the differential change in antireflux medication use between groups before and after surgery.
A total of 16,640 patients underwent gastric bypass, and 26,724 patients underwent sleeve gastrectomy. Before surgery, GERD medication use was higher among patients who underwent gastric bypass (62.4%; 95% confidence interval [CI]: 62.0%-63.7%) compared with patients who underwent sleeve gastrectomy (60.1%; 95% CI: 59.3%-60.9%). Five years after surgery, GERD medication use was lower in patients who underwent gastric bypass (47.8%; 95% CI: 46.3%-49.3%) compared with patients who underwent sleeve gastrectomy (53.7%; 95% CI: 50.5%-56.9%). The differential decrease from baseline GERD medication use was greater for patients who underwent gastric bypass at 2 years (-4.1 percentage points [pp]; 95% CI: -1.7 to -6.5 pp), 3 years (-4.3 pp; 95% CI: -1.6 to -7.0 pp), 4 years (-6.9 pp; 95% CI: -4.1 to -9.6 pp), and 5 years (-8.3 pp; 95% CI: -3.7 to 12.8 pp) after surgery.
Though use of antireflux medication decreased following both procedures, gastric bypass was associated with a greater reduction in antireflux medication use 5 years after surgery compared with sleeve gastrectomy. Understanding the long-term comparative effectiveness of these common bariatric operations may better inform treatment decisions among patients and surgeons.
胃食管反流病（GERD）在接受减重手术的肥胖患者中很常见。虽然胃旁路术和袖状胃切除术是美国最常见的减重手术，但它们在 GERD 药物使用方面的长期比较效果尚不清楚。
比较胃旁路术和袖状胃切除术对反流药物使用的长期效果。
全国住院减重手术队列。
这是一项对 2012 年 1 月 1 日至 2017 年 12 月 31 日期间接受胃旁路术和袖状胃切除术的 Medicare 受益人的回顾性研究。采用差异法分析评估手术前后两组间抗反流药物使用的差异变化。
共有 16640 例患者接受胃旁路术，26724 例患者接受袖状胃切除术。手术前，胃旁路术组患者的 GERD 药物使用率较高（62.4%；95%置信区间[CI]：62.0%-63.7%），而袖状胃切除术组患者的 GERD 药物使用率较低（60.1%；95% CI：59.3%-60.9%）。手术后 5 年，胃旁路术组患者的 GERD 药物使用率（47.8%；95% CI：46.3%-49.3%）较袖状胃切除术组患者（53.7%；95% CI：50.5%-56.9%）低。胃旁路术组患者从基线 GERD 药物使用率的下降幅度在术后 2 年（-4.1 个百分点[pp]；95% CI：-1.7 至-6.5 pp）、3 年（-4.3 pp；95% CI：-1.6 至-7.0 pp）、4 年（-6.9 pp；95% CI：-4.1 至-9.6 pp）和 5 年（-8.3 pp；95% CI：-3.7 至 12.8 pp）更大。
尽管两种手术均降低了抗反流药物的使用，但与袖状胃切除术相比，胃旁路术术后 5 年抗反流药物的使用减少幅度更大。了解这些常见减重手术的长期比较效果，可能会为患者和外科医生的治疗决策提供更好的信息。
