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. 2025 Mar;35(3):941-945.
doi: 10.1007/s11695-025-07692-0. Epub 2025 Jan 27.

Continuous PPI Treatment After Gastric Bypass Increases the Risk of Pathological PTH Levels at 10 Years Postoperatively

Katharina Stevens  1 , Hella Hultin  2 , Magnus Sundbom  3
Affiliations

Continuous PPI Treatment After Gastric Bypass Increases the Risk of Pathological PTH Levels at 10 Years Postoperatively

Katharina Stevens et al. Obes Surg. 2025 Mar.

Abstract

Background: Apart from massive weight loss, metabolic and bariatric surgery, especially gastric bypass (Roux-en-Y gastric bypass [RYGB]), can cause nutritional deficiencies. Proton pump inhibitors (PPI), relatively often used after RYGB, are associated with reduced calcium absorption. We have studied the long-term impact of PPI upon calcium homeostasis among RYGB patients.

Methods: In the Scandinavian Obesity Surgery Registry (SOReg), 550 primary RYGB patients, with eGFR > 60 mL/min/1.73 m2, had PTH and 25-OH D levels registered at 10 years. To avoid the impact of hypovitaminosis D, those with 25-OH D > 75 nmol/L were selected.

Results: At 10 years, 10.3% of patients reported continuous PPI treatment, i.e., daily use during the last month. In an age adjusted logistic regression model, continuous PPI treatment was associated with a quadruple risk (OR: 4.65 [1.54-14.04]) of having a pathological PTH level (> 7 pmol/L).

Conclusion: This unique study has shown a correlation between continuous PPI use and pathological PTH levels, thereby inferring that the medication may have detrimental effects upon calcium homeostasis among gastric bypass patients. The risk of having pathological PTH levels was more than tripled among those with PPI treatment, highlighting the importance of specialized follow-up while also suggesting that a limited duration of PPI treatment is preferable.

Keywords: Bariatric surgery; Gastric bypass; Parathyroid hormone; Proton-pump inhibitors.

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Conflict of interest statement

Declarations. Ethics Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to Participate: Informed consent does not apply. Conflict of Interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Proportion of patients with pathological PTH (PTH ≥ 7.0 pmol/L) depending upon PPI treatment
See this image and copyright information in PMC

References

    1. Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg. 2018;29:782–95. - DOI - PubMed
    1. Raza MM, Njdeaka-Kevin T, Polo J, et al. Long-term outcomes of bariatric surgery: a systematic review. Cureus. 2023;15(5). - PMC - PubMed
    1. “Nordiska Riktlinjer För Monitorering Och Supplementering Med Vitaminer/Mineraler Samt Uppföljning Efter Metabol & Bariatrisk Kirurgi - En Uppdatering .” Ucr.Uu.Se, www.ucr.uu.se/soreg/anvandarstod/anvaendarstoed/manualer/nordiska-riktli.... Accessed 7 Dec. 2024.
    1. Chakhtoura MT, Nakhoul NF, Akl EA, et al. Oral vitamin D supplementation for adults with obesity undergoing bariatric surgery. Cochrane Database Syst Rev. 2024;10(10):CD011800. - PMC - PubMed
    1. Gao Z, Liang Y, Zheng C, et al. Prevalence and associated factors of secondary hyperparathyroidism after Roux‐en‐Y gastric bypass: a meta‐analysis. Obes Rev. 2022;23(10). - PubMed