Sa1343 Can Prophylactic PPI Help Reduce Marginal Ulcers After Gastric Bypass Surgery? A Systematic Review and Meta Analysis

included patients undergoing gastric bypass who received a prophylactic course of PPI postoperatively were eligible. Two reviewers independently selected trials and extracted data. The primary outcome was the incidence of marginal ulcers diagnosed on the basis of endoscopic findings. Inverse variance random effect model was used to estimate odds ratio (OR) of ulcers. OR and weighted pooled proportion with corresponding 95% confidence intervals (CI) are reported. Results The strategic search identified 167 citations. A total of 6 studies involving 2878 participants were eligible for inclusion. The weighted pooled proportion of ulcer formation in PPI single group cohort studies was 4.1% (0.2% - 12.6%) (N=891). The odds ratio of marginal ulcer formation comparing PPI to no PPI for 3 cohort studies was 0.50 (0.28 - 0.90, p= 0.02) with low heterogeneity (I2 = 12 %) showing that the PPI group significantly experienced twice less ulceration with PPI treatment compared to no PPI treatment (N=1022). The Newcastle-Ottawa scale was used for study quality assessment. Conclusion Despite the limitations of the current systematic review (only 3 cohort studies included; inherent biases of observational design), this suggests a significant incremental benefit of prophylactic PPI in reducing marginal ulcer after gastric bypass surgery. Prospective randomized trials are needed to further define the role of PPI following gastric bypass surgery and to support their routine use. Sa1344 National Trends and in-Hospital Outcomes of Inflammatory Bowel Disease Patients Undergoing Bariatric Surgery Douglas L. Nguyen, Nimisha K. Parekh, M. Mazen Jamal Background: Recent reports have shown an increasing frequency of obesity among patients with inflammatory bowel disease (IBD), mirroring the increasing prevalence of obesity in the general population. In this study, we seek to determine the frequency of bariatric surgery in the IBD population and the in-hospital outcomes of IBD patients undergoing these surgeries over the last two decades. Methods: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the prevalence of bariatric surgery among IBD patients and to determine in-patient outcomes. Results: The age-adjusted rate of bariatric surgery among IBD patients has increased from 0.036 per 100,000 adults in 1988-1991 to 0.073 per 100,000 adults in 2004- 2006. The mean age of IBD patients undergoing bariatric surgery was 48.07 years ± 17.82. The frequencies of commonly performed surgeries are—biopancreatic diversion (51.7%), Roux-en-Y gastric bypass (35.1%), gastric sleeve (10.3%), and gastric banding (2.9%). Compared to the general population, there was an increased length of hospitalizations post-operatively among patients with IBD undergoing gastric banding (4.82 v 1.29 days, p,0.01), Roux-en-Y gastric bypass (14.68 v 8.99 days, p ,0.01), and biliopancreatic diversion (13.00 v 12.33 days, p ,0.01). Though the age-adjusted post-operative mortality rate for IBD patients was lower in the IBD group compared to the general population (0.089% vs 0.16%, p,0.01), there was a higher post-operative risk for Clostridium difficile colitis in the IBD group compared to the general population (OR 3.70 95% CI 1.87-7.68). However, the rate of other major post-operative complications such as pulmonary embolism, respiratory failure, pneumonia, prolonged mechanical ventilation, and need for re-operations were similar between the two groups. Conclusions: Though there is a two fold increase in rate in bariatric surgery among IBD patients nationally in the last two decades, the estimated rate remains significant lower than the general population. The mortality rate and other major post-operative complications among patients are similar to the general population, indicating that the short-term outcome of carefully selected IBD patients undergoing bariatric surgery is acceptable. Additionally, given significantly higher post-operative risk for Clostridium difficile colitis among IBD patients, early recognition and treatment may reduce length of hospitalization and post-operative morbidity.

Table 2. Demographic and socioeconomic data in groups A and B at 36 months

Sa1345 Prevalence of Mc4r, Lep, Lepr Gene Mutations in Obese Patients Submitted to Bariatric Surgery Barbara Paolini, Irene Del Ciondolo, Cristina Ciuoli, Massimo Vincenzi, Elisa Lapini, Elisa Pasquini, Francesca Cinci, Lucia Ceccarelli, Monia Menci, Matteo Bertelli, Katia Gennai Obesity is the result of genetic, environmental, physiological, social factors. According to the thrifty genotype hypothesis, genetic polymorphisms which promote excessive fat deposition have been preserved in the evolution for millions of years. In particular obesity has been associated with single mutated alleles inherity of 3 genes: LEP which encodes for leptin, LEPR for leptin receptor, MC4R for melanocortin4 receptor. The aim of our study was to evaluate the prevalence of MC4R, LEP, LEPR gene mutations in a group of obese patients submitted to bariatric surgery. The inclusion criteria were: presence of severe obesity (BMI>35), obesity beginning during childhood and familiarity for overweight. METHODS We considered a group of 78 bariatric surgery patients, 62 women (mean preoperative BMI 44,8±7,47) and 16 men (mean preoperative BMI 45,2±8,37). 22 patients were submitted to malabsorbitive procedures, 56 to restrictive procedures. All the patients underwent a preoperative nutritional status examination which included anthropometric measurements, bioimpedance and blood tests. All the patients were genotyped for LEP (NM_000230; 2 exons), LEPR (NM_002303; 18 exons), MC4R (NM_005912; 1 exon); we sequenced exons and introns with Polymerase Chain Reaction (PCR) with direct sequencing. We evaluated nucleotide sequences that caused an aminoacid replacement with Mutation Taster algorithm to discover their eventual pathogenicity and we searched for them in Human Genome Mutation Database (HGMD). We searched even in single nucleotide polymorphisms database (SNP) to exclude polymorphisms. RESULTS A preliminary analysis of the results didn't show any alteration in LEP and LEPR genes but we discovered 4 different mutations in MC4R gene in 6 women. These mutations caused an aminoacid substitution in the melanocortin receptor and they were considered pathogenic by Mutation Taster. 2 of them, according to HGMD (p.V103I identified in 3 patients; p. T112M identified in 1 patient) had already been associated to autosomal dominant obesity phenotype, 1 of them (p.I251L identified in 1 patient) has a dubious clinical implication and 1 of them (p.Y302D identified in 1 patient) had never been discovered before. Searching these mutations in dbSNP, we found out that the missense mutations (p.V1031 e p.I251L) had been recorded respectively, with frequencies close to 1% (rs2229616) and ranging from 0,6% up to 0,9% (rs52820871). CONCLUSIONS In our sample, representative of the Italian population affected by non

Sa1343 Can Prophylactic PPI Help Reduce Marginal Ulcers After Gastric Bypass Surgery? A Systematic Review and Meta Analysis Valerie Wu Chao Ying, Song Hon Harry Kim, Khurram J. Khan, Forough Farrokhyar, Joanne D'Souza, Scott Gmora, Mehran Anvari, Dennis Hong Objectives Gastric bypass is the most common procedure performed in North America for control of morbid obesity. Marginal ulceration after gastric bypass surgery is a recognised complication and has been reported in 1-16% of patients after gastric bypass surgery (Mac Lean, 1997, Sapala, 1998, DeMaria 2002). There is evidence that acidity may play a role in the disease pathophysiology and it is common practice for bariatric surgeons to begin a prophylactic course of proton pump inhibitors (PPI) postoperatively. We conducted a systematic review and meta analysis of the current literature to estimate the efficacy of prophylactic PPI in reducing the incidence of marginal ulcers after gastric bypass surgery. Methods MEDLINE, EMBASE, CINAHL and the Cochrane Controlled Trials Register were searched using the most comprehensive timeline for each database up to January 2012. Studies that

S-269

AGA Abstracts

AGA Abstracts

weight at 24 and 36 months post-surgery, with no significant pre-operative predictors of weight loss maintenance. Despite this, very little is known regarding the interplay of demographic and socioeconomic factors and the effect on post-operative weight re-gain. Our objective was to identify demographic and socioeconomic predictors of weight re-gain 3 years post-bariatric surgery. Methods: A retrospective, cohort study was performed at the Central New York Bariatric Center, an accredited Level 1A institution, on patients undergoing bariatric surgery over a 5-year period (1/1/2003-12/31/2008). Charts of 656 subjects were reviewed for pre-operative demographic, socioeconomic, and medical data. Demographic and socioeconomic variables included gender, race, marital status, level of education, employment status, insurance type, and urban versus rural residence. Post-operative weight gain, complications, and resolution of co-morbid conditions up to 36 months were also assessed. Urban area boundaries were defined by the 2000 Census Bureau of New York State. Patients with at least 18 months of follow-up were included in the study. Statistical analysis was performed by the Center for Research and Evaluation at SUNY Upstate Medical University. Descriptive statistics compared subjects with post-operative weight gain versus those with weight loss maintenance at 24 and 36 months (Group A=gained weight, Group B=maintained weight loss). A prediction model was built using multivariate logistic regression analysis. Results: Of the 622 subjects meeting inclusion criteria, 61% (218/359) and 66% (174/263) gained weight at 24 and 36 months, respectively. At 24 months, there was a statistically significant difference in weight re-gain between Caucasian (63%) and non-Caucasian (37%) subjects (p=0.003). However, this significance was not seen at 36 months. At 24 and 36 months, the remaining variables did not confer a significant difference in weight re-gain post-bariatric surgery. See Tables 1 and 2. Conclusions: Caucasian subjects had significant weight re-gain at 24 months post-bariatric surgery. No additional statistically significant demographic or socioeconomic predictive factors of weight re-gain were identified in this 3-year review. To our knowledge, this is the first study evaluating demographic and socioeconomic predictive factors of weight re-gain up to 36 months post-bariatric surgery. Table 1. Demographic and socioeconomic data in groups A and B at 24 months