Incidence of marginal ulcer after RYGB surgery. Is there a role for iodine in preventing microbe-induced damage? ‘Systematic review and meta-analysis’

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Abstract Background: Roux-en-Y gastric bypass (RYGB) surgery is currently considered one of the most common operations performed. RYGB may lead to several surgical and nutritional complications. The nature of the surgical procedure may increase the risk of nutritional deficiencies; to address this, nutrients, such as iodine—which is considered to have antimicrobial activity—are pumped into the gastrointestinal tract. Marginal ulcers are also common complications after RYGB operations. Objective: To investigate the incidence of marginal ulcers as an indication of the potential harmful activity of microbes that had not been destroyed by iodide in the stomach. Methodology: A comprehensive literature search was conducted for retrospective studies that measured the incidence of marginal ulcers after RYGB surgery, using the PubMed, ScienceDirect and Cochrane databases. The meta-analysis was conducted using the Mantel–Haenszel random effect method for comparison. Results: This systematic review and meta- analysis shows that the risk of incidence of marginal ulcers is 240 times higher in bariatric patients than it is in the general population. It was also found that some confounders that may induce the risk of marginal ulcer had a non-significant association between the use of non-steroidal anti-inflammatory drugs (NSAIDs; risk ratio [RR] = 1.15), proton pump inhibitors (PPIs; RR = 1.18), smoking (RR = 19.37) and Helicobacter pylori (H. pylori; RR = 1.36). Conclusion: High heterogeneity between the studies prevents a definitive conclusion; however, taken together with all the potential causes of marginal ulcer, the findings suggest that the antimicrobial role of iodine may be affected by the reduction of the stomach size after bariatric surgery. Thus, marginal ulcers may occur. More research is required to examine the link between iodine status and incidence of infection in the bariatric population more closely. Prospective studies may be more appropriate for this kind of research to lessen the potential sources of bias and confounding factors that may be present in retrospective studies.