A cohort study conducted at the Sint Lucas Andreas Zienkenhuis Center for Bariatric Surgery in Stettan showed that routine use of proton pump inhibitors (PPIs) reduces the risk of marginal ulcers after laparoscopic Roux-en-Y gastric bypass (LRYGB). The study was published in the online edition of the journal Surgery for Obesity and Related Diseases. LRYGB is currently the most commonly performed bariatric procedure worldwide, accounting for approximately 47% of all bariatric procedures. Gastrojejunostomy marginal ulceration is a serious complication of LRYGB, and data in the literature suggest that this complication occurs in 1% to 16% of LRYGB patients. Some medical centers routinely use PPIs to prevent postoperative marginal ulcers after LRYGB, but guideline recommendations from various societies are inconsistent. For this reason, Dutch investigators performed a retrospective analysis of 610 patients who underwent LRYGB at the center between November 2007 and September 2012 to evaluate the effect of 6-month prophylactic PPI use on the incidence of marginal ulcers. Of these 610 patients, 273 underwent surgery before August 2011 and did not receive routine PPI prophylaxis (historical control group); the remaining 337 underwent surgery after August 2011 and routinely received PPI prophylaxis for at least 6 months after surgery (intervention group). The results showed that marginal ulcers occurred in 6 patients (1.2%) in the intervention group and 20 patients (7.3%) in the historical control group (P=0.001). PPI prophylaxis was an independent protective factor for marginal ulcers (P=0.007). Five patients in the historical control group required surgery for marginal ulcers; other patients with marginal ulcers received PPI monotherapy or combined with aluminum thioglycollate therapy. Patients in the intervention group were less likely to have other gastrointestinal complications. The investigators say the study is the first to follow patients with and without PPI prophylaxis after LRYGB surgery for a relatively long time. The results showed that PPI prophylaxis had a protective effect on postoperative marginal ulcers, and the investigators accordingly recommended the routine use of PPI after LRYGB. in addition, PPI also had a preventive effect on other abdominal symptoms, thus helping to reduce unnecessary gastroscopies. However, the above conclusions still need to be verified by more prospective studies. Reviewed by Zhifei Li: PPI has a good effect of inhibiting gastric acid and therefore protecting gastric mucosa from ulcers. Also, PPI has a good therapeutic effect on gastroesophageal reflux disease. Therefore, PPI is an effective treatment drug for gastroesophageal reflux symptoms that occur after bariatric surgery (e.g. gastric bypass, sleeve gastrectomy) and for ulcer problems that arise.