腹腔镜胃旁路术和袖状胃切除术术后质子泵抑制剂的使用：一项基于全国登记的队列研究。
Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy: a nationwide register-based cohort study.
机构信息
Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark.
Upper GI and HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark.
出版信息
Int J Obes (Lond). 2024 Nov;48(11):1613-1619. doi: 10.1038/s41366-024-01593-5. Epub 2024 Jul 23.
BACKGROUND/OBJECTIVES: L-RYGB and L-SG are the dominant bariatric procedures worldwide. While L-RYGB is an effective treatment of coexisting gastroesophageal reflux disease (GERD), L-SG is associated with an increased risk of de-novo or worsening of GERD. The study aimed to evaluate the long-term use of proton pump inhibitors (PPI) following laparoscopic Roux-en-Y gastric bypass (L-RYGB) and sleeve gastrectomy (L-SG).
SUBJECTS/METHODS: This nationwide register-based study included all patients undergoing L-RYGB or L-SG in Denmark between 2008 and 2018. In total, 17,740 patients were included in the study, with 16,096 and 1671 undergoing L-RYGB and L-SG, respectively. The median follow up was 11 years after L-RYGB and 4 years after L-SG. Data were collected through Danish nationwide health registries. The development in PPI use was assessed through postoperative redeemed prescriptions. GERD development was defined by a relevant diagnosis code associated with gastroscopy, 24 h pH measurement, revisional surgery or anti-reflux surgery. The risk of initiation of PPI treatment or GERD diagnosis was evaluated using Kaplan-Meier plots and COX regression models. The risk of continuous PPI treatment was examined using logistic regression modeling.
RESULTS
The risk of initiating PPI treatment was significantly higher after L-SG compared with L-RYGB (HR 7.06, 95% CI 6.42-7.77, p < 0.0001). The risk of continuous PPI treatment was likewise significantly higher after L-SG (OR 1.45, 95% CI 1.36-1.54, p < 0.0001). The utilization of PPI consistently increased after both procedures. The risk of GERD diagnosis was also significantly higher after L-SG compared with L-RYGB (HR 1.93, 95% CI 1.27-2.93, p < 0.0001).
CONCLUSIONS
The risk of initiating and continuing PPI treatment was significantly higher after L-SG compared with L-RYGB, and a continuous increase in the utilization of PPI was observed after both procedures.
背景/目的：L-RYGB 和 L-SG 是全球主要的减重手术。虽然 L-RYGB 是治疗并存胃食管反流病（GERD）的有效方法，但 L-SG 与新发或恶化的 GERD 风险增加有关。本研究旨在评估腹腔镜 Roux-en-Y 胃旁路术（L-RYGB）和袖状胃切除术（L-SG）后质子泵抑制剂（PPI）的长期使用情况。
受试者/方法：这是一项基于全国登记的研究，纳入了 2008 年至 2018 年期间在丹麦接受 L-RYGB 或 L-SG 的所有患者。共纳入 17740 例患者，其中 16096 例和 1671 例分别接受 L-RYGB 和 L-SG。L-RYGB 后的中位随访时间为 11 年，L-SG 后的中位随访时间为 4 年。数据通过丹麦全国卫生登记处收集。通过术后报销处方评估 PPI 使用的发展情况。GERD 的发展通过与胃镜、24 小时 pH 测量、翻修手术或抗反流手术相关的相关诊断代码来定义。使用 Kaplan-Meier 图和 COX 回归模型评估 PPI 治疗开始或 GERD 诊断的风险。使用逻辑回归模型检查连续 PPI 治疗的风险。
结果
与 L-RYGB 相比，L-SG 后开始 PPI 治疗的风险显著更高（HR 7.06，95%CI 6.42-7.77，p<0.0001）。与 L-RYGB 相比，L-SG 后连续 PPI 治疗的风险也显著更高（OR 1.45，95%CI 1.36-1.54，p<0.0001）。两种手术方式后，PPI 的使用均持续增加。与 L-RYGB 相比，L-SG 后 GERD 诊断的风险也显著更高（HR 1.93，95%CI 1.27-2.93，p<0.0001）。
结论
与 L-RYGB 相比，L-SG 后开始和继续 PPI 治疗的风险显著更高，两种手术方式后 PPI 的使用均持续增加。
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