Interactions between calcium metabolism and anti-reflux medication after sleeve gastrectomy
Sperker C, Abrahim A, Brix J, Saalabian A, Loetsch B, Russold E, Hofmann-Strommer P, Landsiedl A, Schermann M and Grunberger T
Krankenanstalt Rudolfstiftung, Austria
: Endocrinol Diabetes Res
Abstract
Introduction: Malabsorption and micronutrient deficiencies are known problems after bariatric surgery. Therefore, supplementation and regular controls are inevitable. Calcium (Ca2+) levels, which may be disrupted after malabsorptive bariatric procedures are known to depend on gastric pH levels. Objectives: To determine the effect of proton pump inhibitors (PPI) on Ca2+, parathyroid gland hormone (PTH) and vitamin D levels after sleeve gastrectomy (SG). Methods: All patients who underwent SG between 2008 and 2013 were enrolled in our follow-up program. The patients were examined preoperatively and then four times during the first year. Ca2+ metabolism and weight parameters were monitored. All the patients received 3000 mg of Ca2+ carbonate (equivalent to 1200 mg of Ca2+), 800 IE of vitamin D, as well as one multivitamin tablet daily. All the parameters were then analyzed for associations with PPI intake. Results: Data of 385 out of 400 (96.2%) patients were analyzed after 1 year of follow-up (3.8% lost to follow-up). Thirty nine (10.1%) patients took PPI for at least three months during the first year. The Ca2+ levels were significantly lower (p<0.0001) in the PPI group in comparison to the non-PPI group, although neither of the groups showed hypocalcaemia. The PTH levels showed an opposite behavior (p<0.0001). Conclusions: Our data show that higher gastric pH levels caused by PPI intake negatively influence Ca2+ absorption. Therefore, Ca2+ and PTH levels should be monitored, especially in patients receiving PPI therapy after SG.
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