Background

Gastroesophageal reflux disease (GERD) is common in patients with obesity and different bariatric procedures have different effects on the symptoms. There is little long-term data regarding acid suppression therapy (AST: proton pump inhibitor or H2-blocker) use after bariatric surgery.

Methods

Retrospective data of patients with institutional health insurance who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2009-2016 was analyzed. Pre- and post-surgical AST use was compared, and EGD findings if performed.

Results

There were 261 (70.5%) RYGB and 109 (29.5%) SG patients; these two groups were comparable in age, gender distribution, hypertension, obstructive sleep apnea, and COPD. Diabetes was more common among RYGB patients (42.9% vs. 23.9% SG, p=0.001). Over a median follow-up of 5.5 ± 2.1 years, more RYGB patients were found to be on AST post- than pre-surgery (34.9% vs 20.1%, p<0.05). Similarly, more SG patients were on AST post- than pre-surgery (41.3% vs. 20.2%, p<0.05). There was no difference between RYGB and SG in prevalence of esophagitis or gastritis on endoscopy, but 28 (10.8%) RYGB patients had ulcer disease, compared to zero SG patients (p<0.05).

Conclusions

Our study demonstrates increased AST use after both SG and RYGB compared to pre-surgery. While RYGB patients could have been on AST for ulcer disease post-surgery, there was no difference in rates of esophagitis between the two groups. Regardless, preoperative AST use should not be the sole determinant of procedure choice; more accurate predictors of GERD and AST use after bariatric surgery are needed.