Predictors of marginal ulcer after gastric bypass: a systematic review and meta-analysis

• Published in: Journal of gastrointestinal surgery 2023-06, Vol.27 (6), p.1066-1077
• Main Authors: Beran, Azizullah, Shaear, Mohammad, Al-Mudares, Saif, Sharma, Ishna, Matar, Reem, Al-Haddad, Mohammad, Salame, Marita, Portela, Ray, Clapp, Benjamin, Dayyeh, Barham K. Abu, Ghanem, Omar M.
• Format: Article
• Language: English
• Subjects: Anti-inflammatory agents; Bias; Diabetes; Female; Gastric Bypass - adverse effects; Gastroenterology; Gastrointestinal surgery; Hepatology; Humans; Hypertension - complications; Infections; Medicine; Medicine & Public Health; Meta-analysis; Nonsteroidal anti-inflammatory drugs; Obesity; Obesity, Morbid - complications; Obesity, Morbid - surgery; Original Article; Peptic Ulcer - etiology; Peptic Ulcer - surgery; Proton Pump Inhibitors; Retrospective Studies; Risk Factors; Surgery; Surgical outcomes; Systematic review; Ulcers; Weight control
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-023-05619-7

Introduction Marginal ulcer (MU) is a common complication following Roux-en-Y gastric bypass (RYGB) with an incidence rate of up to 25%. Several studies have evaluated different risk factors associated with MU with inconsistent findings. In this meta-analysis, we aimed to identify the predictors of MU after RYGB. Methods A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through April 2022. All studies that used a multivariate model to assess risk factors for MU after RYGB were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies were obtained within a random-effects model. Results Fourteen studies with 344,829 patients who underwent RYGB were included. Eleven different risk factors were analyzed. Meta-analysis demonstrated that Helicobacter pylori (HP) infection (OR 4.97 [2.24–10.99]), smoking (OR 2.50 [1.76–3.54]), and diabetes mellitus (OR 1.80 [1.15–2.80]), were significant predictors of MU. Increased age, body mass index, female gender, obstructive sleep apnea, hypertension, and alcohol use were not predictors of MU. There was a trend of an increased risk of MU associated with nonsteroidal anti-inflammatory drugs (OR 2.43 [0.72–8.21]) and a lower risk of MU with proton pump inhibitors use (OR 0.44 [0.11–2.11]). Conclusions Smoking cessation, optimizing glycemic control, and eradication of HP infection reduce the risk of MU following RYGB. Recognition of predictors of MU after RYGB will allow physicians to identify high-risk patients, improve surgical outcomes, and reduce the risk of MU.