Is open-capsule proton pump inhibitor associated with faster healing time for marginal ulceration after Roux-en-Y gastric bypass?

Autor:	Yoo H; Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Firkins SA; Gastroenterology, Hepatology and Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Kwon AG; Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Imperio-Lagabon K; Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Bajwa R; Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Flora B; Center for Human Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio., Simons-Linares CR; Gastroenterology, Hepatology and Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: simonsc@ccf.org.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2024 Mar; Vol. 20 (3), pp. 254-260. Date of Electronic Publication: 2023 Oct 14.
DOI:	10.1016/j.soard.2023.10.003
Abstrakt:	Background: Marginal ulceration (MU) is a significant cause of morbidity after Roux-en-Y gastric bypass (RYGB). Proton pump inhibitors (PPIs) are the primary treatment. Prior limited data suggest that open-capsule PPIs (OC-PPIs) improve MU healing compared with intact-capsule PPIs (IC-PPIs), necessitating further validation. Objectives: We aimed to compare healing times of MU after RYGB when treated with OC-PPIs versus IC-PPIs. Setting: Tertiary academic center, United States. Methods: We retrospectively analyzed patients with prior RYGB diagnosed with MU from 2012 to 2022. Patients requiring mechanical closure without documented healing and without clear PPI prescriptions were excluded. The primary outcome was time to ulcer healing. Log-rank testing and Kaplan-Meier survival curve analyses were performed to compare MU healing times when treated with OC-PPIs versus IC-PPIs. Subgroup analyses further characterized ulcer healing times based on type and dosage of PPI used. Results: A total of 108 patients were included for final analysis (38 received OC-PPIs and 70 received IC-PPIs). Treatment with OC-PPIs significantly decreased MU healing time compared with IC-PPIs (146.18 versus 226.14 d; p = .018). However, when stratified by PPI potency, the positive effect of opening the capsule lost significance. Conclusion: In this study, OC-PPIs significantly improved MU healing times compared with IC-PPIs in RYGB patients, consistent with prior data. However, on subgroup analysis comparing therapy with similar PPI potency, the MU healing time did not differ with respect to administration method. These results highlight the need for a prospective randomized trial to compare the true effect of administration method. (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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