After bariatric surgery most UK centres discharge patients on an orodispersible proton‑pump inhibitor (commonly lansoprazole 30 mg once daily) for 3–6 months to prevent marginal (anastomotic) ulcers; use orodispersible, liquid or opened‑capsule formulations early post‑op and review at 3 months with nutrient checks if PPI therapy continues.
Why acid suppression matters after bariatric surgery
- Purpose: PPIs reduce acid exposure at the gastro‑jejunal anastomosis and are used to prevent and treat marginal ulcers after Roux‑en‑Y gastric bypass (RYGB) and to manage reflux after sleeve gastrectomy (LSG). Prophylactic PPI use is standard practice in many UK bariatric units.
- Procedure differences: LSG patients have higher rates of new or worsening GERD and are more likely to remain on PPIs long‑term than RYGB patients.
Lansoprazole: practical prescribing and formulation guide
| Formulation | Typical dose | When to use | Key advantage |
|---|---|---|---|
| Orodispersible lansoprazole | 30 mg once daily | Routine discharge; early post‑op | Rapid dissolution in small pouch; suitable if swallowing difficult. |
| Opened capsule (mixed per pharmacy advice) | 30 mg once daily | If orodispersible unavailable; NG/JE tube | Improved dissolution/absorption after RYGB. |
| Liquid PPI | equivalent dose | Nil by mouth or early weeks | Easy administration; check low‑sugar options. |
| Standard enteric capsule | 30 mg once daily | Later post‑op when pouch normal | Widely available; may not dissolve reliably early. |
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Recommended duration and review
- Typical course: 3–6 months prophylaxis is common; many units use 6 months routinely but individualise by risk (smoking, NSAID use, H. pylori). Review at 3 months to decide continuation.
Risks and monitoring
- Nutrient checks: If PPI use continues beyond a few months, check serum magnesium and consider vitamin B12 testing; monitor iron if symptomatic.
- Bone health: Long‑term PPI use is associated with a modest increase in fracture risk in observational studies—ensure adequate calcium and vitamin D and assess osteoporosis risk if therapy is prolonged.
- Medication safety: Avoid NSAIDs where possible; test/treat H. pylori if present; liaise with bariatric team before stopping or changing PPI formulation.
Quick action checklist for patients
- At discharge: patient likely prescribed lansoprazole 30 mg orodispersible OD.
- 3‑month review: assess symptoms, consider stopping if no indication; if continuing, order magnesium and B12 and document surgery type (RYGB vs LSG).
- Urgent signs: severe abdominal pain, vomiting, melaena or haematemesis → urgent bariatric clinic or A&E.