Cohort studyindependent cross-checkabstract checked I-BAR-144 standard review
Danish study: acid medicines after sleeve vs bypass
Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy: a nationwide register-based cohort study.
Overview
Gormsen et al.. Int J Obes (Lond) 2024 · PMID 39043831 · DOI 10.1038/s41366-024-01593-5
Sleeve patients were much more likely to start acid-reducing medicines and to keep taking them than bypass patients.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
PPI use after SG vs RYGB
- How was the study done?
National cohort
- How many people, animals or samples were studied?
17,740
- What was actually found?
More PPI use after SG
- How large was the observed effect?
HR 7.06
- What do the results mean in everyday life?
Many sleeve patients need acid medicines
- What are the study's limitations?
Small SG group
- What does it say about Elawady's specific claim?
Partly supports
- Do the results apply to Germany and Europe?
Directly European
- What can explicitly not be concluded from this study?
Lifelong need for all
Scientific in-depth review
1. Full reference
- Authors
- Gormsen et al.
- Journal
- Int J Obes (Lond)
- Year
- 2024
- Identifier
- PMID 39043831 DOI 10.1038/s41366-024-01593-5
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref API
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement (PubMed record): The authors declare no competing interests. The funding sources had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. The corresponding author had full access to the data and had final responsibility for the decision to submit the manuscript for publication.
2. Research question
How does long-term PPI use differ after RYGB and SG?
3. Study design and population
- Study design
- Cohort study – Nationwide register-based cohort (Denmark)
- Population
All patients with L-RYGB or L-SG in Denmark 2008-2018
- Country
Denmark
- Period
2008-2018; median follow-up 11 y (RYGB), 4 y (SG)
- Sample size
17,740 (16,096 RYGB, 1,671 SG)
- Inclusion and exclusion criteria
National registries
4. Methods and endpoints
- Exposure / intervention
L-SG
- Comparator
L-RYGB
- Endpoints
PPI initiation, continuous PPI use, GERD diagnosis
- Statistical methods
Kaplan-Meier, Cox, logistic regression
5. Actual results
- Results
PPI initiation HR 7.06 (6.42-7.77) SG vs RYGB; continuous PPI OR 1.45 (1.36-1.54); GERD diagnosis HR 1.93 (1.27-2.93). PPI utilisation increased after both procedures.
- Absolute risks
not reported in abstract
- Authors' conclusion
Risk of initiating and continuing PPI treatment was significantly higher after SG; PPI use increased after both procedures.
6. Strengths
- Nationwide prescription data
7. Weaknesses
- Different follow-up lengths
- Small SG group
- PPI use also for other indications
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Confounding by indication (procedure choice).
9. Assessment of the statistical interpretation
Relative measures only in abstract; absolute proportions on lifelong PPI not given.
10. Relevance to the specific claim
Shows PPI use is much more frequent after sleeve, partly supporting the "acid drugs" part, but does not show that all patients need lifelong PPIs.
11. Independent contrary findings
12. Transferability to Germany and Europe
Danish.
13. Overall methodological judgement
Supports frequent PPI need after sleeve; not universality.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Proportion on continuous PPIs.
15. Linked fact checks
- After sleeve gastrectomy reflux is inevitable, and patients must take acid-suppressing drugs for life. – Studies with mixed or unclear results
- Sleeve gastrectomy substantially increases gastro-oesophageal reflux disease and erosive oesophagitis. – Studies supporting the claim