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The laparoscopic sleeve gastrectomy (or sleeve) is considered to be a high pressured system. What that means: functionally, the stomach remains intact with preservation of the gastroesophageal sphincter at the top of the stomach and the pyloric sphincter at the bottom. But, since the fundus or excess stomach has been removed, the pressure on those sphincters is greater. In the first year post-op, this high pressure can lend people who have never had symptoms of GERD or reflux to require treatment with Proton-Pump Inhibitors. Your doctor may even place you on a post-operative PPI as a prophylaxis to prevent this occurrence and to protect your stomach as it heals.
According to Dr. David C. Metz (1), long term use of Proton-Pump Inhibitors can predispose a patient to the need for ongoing therapy. When a patient tries to discontinue the use of the medication, it can produce a rebound hypersecretion state by the stomach in which acid is overproduced. In essence, your body has become dependent on the suppression caused by the drug to keep acid production to a minimum.
Proton-Pump Inhibitors can also have potential interactions with the absorption of other medications. According to Johnson and Oldfield, it can alter the way your calcium, iron, magnesium, B-12, and Plavix or clopidogrel are absorbed (2). With PPIs being the most widely used class of drugs and their ready availability over the counter at local pharmacies like Walgreens and CVS, they have proved to be relatively safe with minimal side effects that warrant the patient discontinuing use of the drug. Given the new attention on the way they lessen the absorption of some key minerals and vitamins, like calcium, new studies are taking place to determine the long term impact on bone health. Studies show that PPIs taken for longer than 1 year were associated with an increased risk of hip fractures, with the adjusted rate of hip fractures significantly higher in patient’s prescribed long-term high dose PPIs and the risk progressively increased with the duration of PPI treatment (3).
After having the sleeve gastrectomy, discuss the use of Proton-Pump Inhibitors frequently with your doctor and attempt to wean off the drug as quickly as you are instructed. Discuss with your primary care provider the need to have bone density scans or similar testing to monitor bone health. Your overall health is partly determined by your compliance with supplemental vitamins and minerals, lab draws, and routine follow-up. Remember to follow the recommendations of your provider to ensure you are doing everything on your part to remain healthy. Remember: skinny does not equal healthy.
For more information regarding Proton-Pump Inhibitors and the risks involved in long-term use, give our office a call at 940-249-9009.

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