Which Factors Correlate with Marginal Ulcer After Surgery for Obesity?

Marginal ulcer is one of the most common complications after Roux-en-Y gastric bypass and is defined as an ulceration of any depth at or near the gastrojejunal anastomosis. Different risk factors have been advocated to be the causative agent.

The weighted discharges from the Nationwide Inpatient Sample from 2003 to 2011 were used to assess for risk factors to develop marginal ulcer such as Helicobacter pylori infection, chronic nonsteroidal anti-inflammatory use, chronic aspirin use, alcohol dependence, smoking, hypertension, and diabetes mellitus type II.

Chronic nonsteroidal anti-inflammatory drug use was the most significant risk factor for marginal ulcer, followed by Helicobacter pylori infection, obstructive sleep apnea, female sex, smoking, and alcohol dependence in decreasing order. Diabetes mellitus and hypertension were found to slightly increase the risk for marginal ulcer. The use of aspirin was found to be a minor risk factor during univariate analysis but a protective factor during multivariate analysis.

Multiple well-documented single factors are related to the genesis of a marginal ulcer, although it is likely that a combination of risk factors is responsible for this problem. These risk factors should be identified and removed or controlled.