Giannopoulos Spyridon, Athanasiadis Dimitrios I, Clapp Benjamin, Lyo Victoria, Ghanem Omar, Puzziferri Nancy, Stefanidis Dimitrios
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas.
Surg Obes Relat Dis. 2023 Apr;19(4):303-308. doi: 10.1016/j.soard.2022.10.002. Epub 2022 Oct 10.
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.
Assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis.
Survey of medical directors of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited centers.
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 Program-accredited programs detailing questions related to surgeons' use of PPI after RYGB including patient selection, medication, dosage, and treatment duration.
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.
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.
在Roux-en-Y胃旁路术（RYGB）后，质子泵抑制剂（PPI）常被用于预防边缘性溃疡。术后PPI治疗的最佳持续时间尚不清楚，以尽量减少溃疡的发生。
评估减重外科医生在术后PPI预防方面的实践差异。
对代谢与减重手术认证及质量改进计划认证中心的医学主任进行调查。
美国代谢与减重外科学会研究委员会成员于2021年11月开发并实施了一项基于网络的匿名调查，对象是代谢与减重手术认证及质量改进计划认证项目的减重外科医生，详细询问了与RYGB术后医生使用PPI相关的问题，包括患者选择、药物、剂量和治疗持续时间。
112名外科医生完成了调查（回复率：52.6%）。85.4%的外科医生在所有患者住院期间开具PPI，3.9%为选择性患者开具，10.7%根本不开具。出院后，90.3%的医生开具PPI。住院期间最常使用泮托拉唑（38.5%），而出院后最常开具奥美拉唑（61.7%）。术后PPI给药持续时间各不相同；43.6%的患者为3个月，20.2%为1个月，18.6%为6个月。最后，外科医生的执业环境和病例数量与RYGB术后预防性PPI给药的持续时间无关。
RYGB术后外科医生在PPI给药实践方面差异很大，这可能与PPI给药最佳持续时间的比较证据和指南有限有关。需要进行具有客观结果指标的大型前瞻性临床试验，以确定RYGB术后PPI预防的最佳实践，以实现最大的临床效益。
