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Patients with sleeve gastrectomy, gastric bypass, and duodenal switch surgery must take acid reduction medications called Proton Pump Inhibitors or PPI’s such as Omeprazole or Nexium.

Because after surgery, your stomach has staples, it is producing more acid, you have to take PPI’s during the first three months after surgery without fail, whether you feel acidity or not; this minimizes the risk of complications such as gastroesophageal reflux and/or ulcer formation.

Studies have shown that taking PPI’s reduces considerably the risk of ulcer formation after surgery.

After three months, most patients will be able to stop taking them; this reduces the risk of having nutrient deficiencies such as calcium, magnesium, iron, and Vitamin B12 and limits complications associated with these deficiencies, namely bone fractures, and cardiac abnormalities.

Patients who take PPI’s for over a year are more likely to experience bone fractures and the risk increases if the patient is taking high doses. This is why calcium supplementation is so important. Calcium citrate is what is usually recommended to patients under PPI therapy.

Hypomagnesia or low levels of magnesium is also another long-term consequence of PPI therapy. Studies reveal that after around 5.5 years after starting PPI therapy, patients show low levels of magnesium. Symptoms include hypotension, arrhythmia, and seizures. Discontinuation of PPI’s usually recover levels of magnesium, but oral and/or IV supplements may be required.

Other long-term complications include infections such as pneumonia. The hypothesis is that an acidic environment reduces the possibility of bacterial colonization, and taking PPI’s makes it easy for infections to occur. Nevertheless, this report was found in patients over 65 years old.

Some patients may need to continue using PPI’s because of their lifestyles, if they smoke or drink, acid symptoms may persist. If acid reflux symptoms persist, a PPI’s may be used on a long-term basis in combination with proper supplementation.

It is uncommon, but some patients with acid reflux continue having acid symptoms, despite the use of PPI’s and that’s when gastric bypass surgery is suggested. Before considering another surgery patients along with their doctor need to explore different dosages of PPIs, different brands, etc.  

In conclusion, PPI’s are a safe drug, however, if you are on long-term use of them it’s important that you take the right supplements to compensate for it and avoid complications.

Always check with your doctor or pharmacist before starting a new medication.