Jérémie Thereaux1, Thomas Lesuffleur2, Sébastien Czernichow3, Arnaud Basdevant4, Simon Msika5, David Nocca6, Bertrand Millat2, Anne Fagot-Campagna7. 1. Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France; University of Bretagne Occidentale, EA 3878 Brest, France. 2. Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France. 3. Department of Nutrition, Hôpital Européen-Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiological Cohort in Population, Villejuif, France. 4. Institute of Cardiometabolism and Nutrition, Heart and Nutrition Department, Paris, France. 5. Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France. 6. Department of Digestive Surgery, CHU de Montpellier, Montpellier, France. 7. Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France. Electronic address: anne.fagot@cnamts.fr.
Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). OBJECTIVE: To assess PPI use at 4 years after bariatric surgery. SETTING: French National Health Insurance. METHODS: Data were extracted from the French National Health Insurance database. All adult obese patients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery. RESULTS: Overall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55-2.25), higher body mass index (OR 1.85; 95% CI 1.35-2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56-2.29). CONCLUSION: At a nationwide scale, continuous PPI treatment is used by 1 of 10 obese patients before bariatric surgery, but by 1 of 4 patients 4 years after surgery. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.
BACKGROUND:Gastroesophageal reflux disease (GERD) is a common obesity-related co-morbidity that routinely is treated by continuous proton pump inhibitor (PPI) therapy. A number of concerns have been raised regarding the risk of de novo GERD or exacerbation of preexisting GERD after sleeve gastrectomy (SG). OBJECTIVE: To assess PPI use at 4 years after bariatric surgery. SETTING: French National Health Insurance. METHODS: Data were extracted from the French National Health Insurance database. All adult obesepatients who had undergone gastric bypass (GBP) (n = 8250) or SG (n = 11,923) in 2011 in France were included. Patients were considered to be on continuous PPI therapy when PPIs were dispensed≥6 times per year. Logistic regression models were used to compute odds ratios for potential risk factors for PPI reimbursement 4 years after surgery. RESULTS: Overall, continuous use of PPIs increased from baseline to 4 years after SG and GBP, from 10.9% to 26.5% (P<.001) and from 11.4% to 21.9% (P<.001), respectively. Among patients who underwent PPI therapy before surgery, those who had undergone SG were more likely to continue PPI therapy 4 years after surgery compared with those who underwent GBP (72.7% versus 59.2%; P<.001). In multivariate analyses, the major risk factors for persistent continuous PPI treatment 4 years after surgery were the following: SG (odds ratio [OR] = 1.87; 95% confidence interval [CI] 1.55-2.25), higher body mass index (OR 1.85; 95% CI 1.35-2.5), and preoperative antidepressant treatment (OR 1.89; 95% CI 1.56-2.29). CONCLUSION: At a nationwide scale, continuous PPI treatment is used by 1 of 10 obesepatients before bariatric surgery, but by 1 of 4 patients 4 years after surgery. SG compared with GBP, higher body mass index, and other coexisting conditions are the 3 major risk factors for medium-term continuous PPI therapy.