Background

Proton pump inhibitors (PPI) are frequently used after gastric bypass to prevent marginal ulceration. The optimal duration of PPI treatment after surgery to minimize ulcer incidence is unclear. Our aim was to assess bariatric surgeon practice variability regarding postoperative PPI prophylaxis.

Methods

Members of the ASMBS research committee developed and administered a web-based anonymous survey in October 2021 to MBSAQIP medical directors detailing questions related to surgeons’ use of PPI after bariatric surgery including patient selection, medication, dosage, and treatment duration.

Results

112 surgeons participated in the survey (response rate: 52.6%). 85.4% of surgeons administered PPIs to all patients during their hospitalization, 3.9% used them selectively, and 10.7% not at all. After discharge, 90.3% prescribed PPIs. Pantoprazole was most often used in the hospital (38.5%), while omeprazole was prescribed by 61.7% of surgeons after discharge at a dose of 40 mg bid (48.9%), 20 mg bid (45.7%), or other (5.4%). Among surgeons who administer PPI selectively, ulcerogenic medication use (20.7%), and preoperative reflux (20.7%) were the most common reasons for PPI use. The duration of PPI administration after surgery varied widely and was influenced by the presence of preoperative gastroesophageal reflux disease (GERD) (Figure 1).

Conclusions

PPI administration practices vary widely among surgeons after bariatric surgery. This variability may be related to the limited available comparative evidence and guidelines on best duration of PPI administration. Large prospective clinical trials with objective outcome measures are needed to define optimal practices for PPI prophylaxis after bariatric surgery to maximize clinical benefit while minimizing cost.