OBJECTIVE: To assess the influence of risk medication and proton pump inhibitor use on ulcer-free survival in patients after bariatric surgery. DESIGN Retrospective cohort study. METHODS By using a retrospective chart review, information was collected about the use of medication among 631 patients who underwent a Roux-and-Y gastric bypass, an omega-loop bypass or received a gastric sleeve. Kaplan-Meier survival estimates were calculated to study the effect of risk medication on the median time to ulcer development after bariatric surgery. The effect of the single and combined use of risk medication with or without proton pump inhibitors was evaluated by Cox proportional hazard models.
RESULTS: The median disease-free survival could not be computed because of the low incidence of ulcers (0.79%). The hazard ratios (HR) for use of any risk medication, NSAIDs, corticosteroids, antiplatelet drugs, anticoagulants and SNRIs were 1.51 (95% confidence interval [CI] 0.17-13.61, p - 0.714), 0.05 (95% CI 0.00- 180,000,000. p 0.761), 0.04 (95% CI 0.00-70,125, p = 0.668). and 4.10 (95% CI 0.68-24.66, p = 0.123), respectively. The hazard ratios for the combinations of NSAIDs with any risk medication or with SNRIs were 3.28 (95% CI 0.36-29.66, p = 0.290) and 7.74 (95% CI 0.86-69.46. p = 0.067) white the hazard ratios for the other combinations could not be calculated. The rare combination of an NSAID, an anticoagulant and an SNRI and the combination of an anticoagulant with an SNRI resulted in a statistically significant higher risk for developing an ulcer (HR 37.52 with 95% CI 4.10-343.19. p = 0.001 and 24.16 with 95% CI 4.03-144.83. p < 0.0001, respectively), despite the use of proton pump inhibitors (HR 37.52 with 95% CI 4.10-343.19. p < 0.001 and 25.45 with 95% CI 4.24-152.70. p = <0.0001. respectively).'
CONCLUSION: Despite the prophylactic use of proton pump inhibitors, we found an association between the development of an ulcer and SNRI use. as well as with the combination of an SNRI and an anticoagulant with or without the use of an NSAID.
|Number of pages||4|
|Publication status||Published - 27 Oct 2017|