PROTON PUMP INHIBITOR ABSORPTION FOLLOWING SLEEVE GASTRECTOMY IMPACTS RESOLUTION OF GERD SYMPTOMS
Pichamol Jirapinyo*, William Dong, Russell D. Dolan, Walter W. Chan, Christopher C. Thompson
Brigham & Women's Hospital, Boston, MA
BACKGROUND: Gastroesophageal reflux disease (GERD) is common following sleeve gastrectomy (SG). Traditionally, treatment of GERD includes acid suppression with proton pump inhibitors (PPIs). Given the effect of SG on accelerating gastric emptying, we hypothesize that open capsule (OC) PPIs may lead to better absorption than intact capsule (IC) PPIs resulting in a higher response rate.
AIMS: To assess and compare the effect of OC PPIs and IC PPIs on treating GERD in patients with SG.
METHODS: A retrospective study was conducted. Included subjects were SG patients with GERD who were prescribed OC or IC PPIs. Demographics, methods of PPI administration, symptom response and amount of weight change were collected. A follow-up period of 3 months was used, as it was the most common endpoint for most PPI trials. Symptom response was defined as reported improvement in GERD symptoms, a decrease in PPI dosage or discontinuation of PPI within 3 months of PPI initiation. The response rates between OC and IC groups were compared using a Chi-squared test. A logistic multivariable regression was used to control for confounders.
RESULTS: A total of 222 SG (183F, age 50±13 years) patients were included. Of these, 158 (71.2%) and 64 (28.8%) received OC and IC PPIs, respectively. At 3 months, the response rates in the OC and IC groups were 52.5% and 28.1% (p=0.001), respectively. The amount of weight change during this period was 12.5±8.3% and 12.8±7.0% total weight loss (TWL) in the OC and IC groups (p=0.79), respectively. On a multivariable regression analysis, OC remained a significant predictor of response to PPI after controlling for age, sex and amount of weight change (OR 5.3 [2.6,10.9], p<0.001). Amount of weight loss was also associated with response to PPI after controlling for age, sex and methods of PPI administration (OR 1.1 [1.0,1.1], p=0.01).
CONCLUSION: Opened capsule PPIs are associated with a higher rate of improvement in GERD symptoms compared to intact capsules in SG patients. Studies are warranted to investigate the absorption of other medications in this patient population.
Back to 2020 Abstracts