P3167 - Exploring Proton Pump Inhibitor Optimization of Post-RYGB Marginal Ulceration Recurrence

Anusha Agarwal, MD¹, Michael Cymbal, DO¹, Varun Aitharaju, MD¹, Heesoo Yoo, MD¹, Alvin Kwon, MD¹, Alison Zhao, BA², Kristelle Imperio-Lagabon, MD¹, Stephen Firkins, MD³, Roma Patel, MD⁴, Bailey Flora, RD¹, C Roberto Simon-Linares, MD^3
1Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Lerner College of Medicine, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Marginal ulceration (MU) remains a major cause of morbidity in patients status post Roux-en-Y gastric bypass (RYGB). In the current literature, which is notably limited, MU recurrence rate varies from 0 to 57%, due to which there remains disputable data regarding optimal approach to evidence-based management of post-RYGB MU with proton pump inhibitor (PPI) use. As such, we aimed to assess the differences in MU recurrence rate in open-capsule (OC) versus intact-capsule (IC) PPI.

Methods: We performed a retrospective study on patients (age greater than or equal to 18 years) at a bariatric clinic at a large tertiary center with a history of RYGB from January 2013 to April 2022 and MU noted on esophagogastroduodenoscopy (EGD). Exclusion criteria included: lost to follow-up, RYGB not done for obesity, lack of MU evidence on EGD reports, insufficient PPI data, lack of MU follow-up. Demographic, clinical, and EGD findings were collected and stored in RedCap. PPI type, dosage, formulation were abstracted pre- and post- MU diagnosis, and patients were stratified in two groups: IC-PPI and OC-PPI. Characteristics and findings were compared using Chi-square, Fisher exact, and two-sample t-tests. Logistical regression analysis was also performed, with primary outcome being rate of MU recurrence. A p-value of < 0.05 was considered significant.

Results: A total of 594 patients were identified. 418 patients were included in the analysis (N=342 in IC-PPI group, N=76 in OC-PPI group). 84.7% were female, median age was 49.0±12.1 years, and average BMI was 31.3±8.0. 9.8% reported smoking, 59.8% reported no alcohol use, and 9.7% report NSAID use at the time of MU diagnosis. For baseline characteristics, a statistically significant difference was only noted in the BMI between the IC-PPI and OC-PPI groups (p=0.04). There was a statistically significant difference in MU recurrence rate with 25.7% in IC-PPI and 13.4% in OC-PPI (p=0.034). Adjusted odds ratio of MU recurrence rate for OC-PPI use was 0.17 (95% CI 0.065-0.43, p=0.000).

Discussion: OC-PPI is associated with lower MU recurrence rate when compared to IC-PPI in post-RYGB MU treatment. Mechanisms of statistically significant decrease in MU recurrence rate with OC-PPI may include superior absorption with open capsule formulation in the setting of altered anatomy post-RYGB. If further validated with prospective studies, these results can further inform optimization of PPI use in clinical practice to lower rates of MU recurrence in RYBG patients.


Disclosures:


Anusha Agarwal, MD¹, Michael Cymbal, DO¹, Varun Aitharaju, MD¹, Heesoo Yoo, MD¹, Alvin Kwon, MD¹, Alison Zhao, BA², Kristelle Imperio-Lagabon, MD¹, Stephen Firkins, MD³, Roma Patel, MD⁴, Bailey Flora, RD¹, C Roberto Simon-Linares, MD³. P3167 - Exploring Proton Pump Inhibitor Optimization of Post-RYGB Marginal Ulceration Recurrence, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.