{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T22:40:41Z","timestamp":1777761641902,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed metabolic and bariatric surgeries worldwide. Marginal ulcers (MU) are a common complication following RYGB, yet their pathophysiology and the contributing risk factors to their development are not fully understood. Materials and Methods: This retrospective cohort study examined patients who underwent RYGB between January 2008 and December 2023, with 1 to 5 years of follow-up. Data collected included patient- and procedure-related risk factors, as well as postoperative MU events. Statistical analysis methods included the independent samples t-tests, multivariate regression, and Cox regression analyses. Results: Our final cohort included 2106 patients and was predominantly female (80.5%), with a mean age of 47.8 \u00b1 12.1 years and body mass index (BMI) of 45.5 \u00b1 7.5 kg\/m2. MU occurred in 241 (11.4%) patients, with a mean time to occurrence of 4.5 \u00b1 0.02 years. History of smoking (HR = 1.87, p &lt; 0.001) and gastroesophageal reflux disease (HR = 2.36, p &lt; 0.001) significantly increased hazard for MU, while proton pump inhibitor use (HR = 0.18, p &lt; 0.001) was associated with reduced hazard. Aspirin exposure, regardless of dose and chronicity, did not impact MU. Conclusions: Our findings highlight the importance of preoperative assessment and counseling in patients planning to undergo RYGB. Patient-related factors should guide postoperative monitoring and prophylaxis of MU, as this remains a debated topic amongst experts.<\/jats:p>","DOI":"10.3390\/medicina62050838","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:32:22Z","timestamp":1777469542000},"page":"838","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comprehensive Analysis of Predictors of Marginal Ulcers After Roux-en-Y Gastric Bypass: A Cohort Review of 2106 Patients"],"prefix":"10.3390","volume":"62","author":[{"given":"Tala","family":"Abedalqader","sequence":"first","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Migliorini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1471-9086","authenticated-orcid":false,"given":"Leonardo Garcia","family":"Cerecedo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9179-6021","authenticated-orcid":false,"given":"Nour","family":"El Ghazal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5484-6706","authenticated-orcid":false,"given":"Joseph","family":"Klim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Boutros","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6174-3287","authenticated-orcid":false,"given":"Simon J.","family":"Laplante","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar M.","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/j.soard.2022.08.013","article-title":"2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery","volume":"18","author":"Eisenberg","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.soard.2024.01.012","article-title":"American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States","volume":"20","author":"Clapp","year":"2024","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.surg.2024.02.035","article-title":"Comprehensive outcomes after Roux-en-Y gastric bypass with a near-complete 15-year follow-up","volume":"176","author":"Jawhar","year":"2024","journal-title":"Surgery"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Salame, M., Jawhar, N., Belluzzi, A., Al-Kordi, M., Storm, A.C., Abu Dayyeh, B.K., and Ghanem, O.M. (2023). Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134336"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/j.soard.2024.06.011","article-title":"Early marginal ulceration prevalence following primary RYGB: A rare events model of the MBSAQIP 2015\u20132021","volume":"20","author":"Kachmar","year":"2024","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1007\/s11695-024-07179-4","article-title":"Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors","volume":"34","author":"Cornejo","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1007\/s00464-012-2280-x","article-title":"Marginal ulcer after Roux-en-Y gastric bypass: What have we really learned?","volume":"26","author":"Timratana","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s00464-020-07650-0","article-title":"Marginal ulceration following Roux-en-Y gastric bypass: Risk factors for ulcer development, recurrence and need for revisional surgery","volume":"35","author":"Liu","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_9","first-page":"273","article-title":"Benefits of Prophylactic Proton Pump Inhibitors after Roux-en-Y Gastric Bypass Surgery: A Retrospective Study","volume":"115","author":"Plaeke","year":"2015","journal-title":"Acta Chir. Belg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gao, X., Dai, S., Wang, G., Li, W., Song, Z., Su, Z., Zhu, S., Zhu, L., and Li, P. (2022). Large Versus Small Gastric Pouch for Roux-en-Y Gastric Bypass in Individuals with Type 2 Diabetes and a Body Mass Index < 35 kg\/m2: Six-Year Outcomes. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.913062"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s11695-021-05850-8","article-title":"Why Size Matters: An Evaluation of Gastric Pouch Size in Roux-en-Y Gastric Bypass Using CT Volumetric Analysis and its Effect on Marginal Ulceration","volume":"32","author":"Ayuso","year":"2022","journal-title":"Obes. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.soard.2015.04.022","article-title":"The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: A historic cohort study","volume":"12","author":"Coblijn","year":"2016","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4821","DOI":"10.1007\/s11695-020-04960-z","article-title":"Which Factors Correlate with Marginal Ulcer After Surgery for Obesity?","volume":"30","author":"Rodrigo","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1007\/s11695-016-2462-z","article-title":"Is Daily Low-Dose Aspirin Safe to Take Following Laparoscopic Roux-en-Y Gastric Bypass for Obesity Surgery?","volume":"27","author":"Kang","year":"2017","journal-title":"Obes. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3540","DOI":"10.1007\/s11695-025-08144-5","article-title":"Vagal-Sparing Versus Non-Vagal-Sparing Roux-en-Y Gastric Bypass: Complications and Weight Outcomes","volume":"35","author":"Abedalqader","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/j.soard.2021.07.017","article-title":"Operative management of recalcitrant marginal ulcers following laparoscopic Roux-en-Y gastric bypass for morbid obesity: A systematic review","volume":"17","author":"Fecso","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s11695-013-1118-5","article-title":"Development of Ulcer Disease After Roux-en-Y Gastric Bypass, Incidence, Risk Factors, and Patient Presentation: A Systematic Review","volume":"24","author":"Coblijn","year":"2014","journal-title":"Obes. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1007\/s11695-024-07078-8","article-title":"Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?","volume":"34","author":"Capaverde","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3005","DOI":"10.1007\/s11695-021-05363-4","article-title":"Incidence and Prognostic Factors for the Development of Symptomatic and Asymptomatic Marginal Ulcers After Roux-en-Y Gastric Bypass Procedures","volume":"31","author":"Wartmann","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.soard.2013.01.017","article-title":"Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: Is the acid pocket to blame?","volume":"9","author":"Gilmore","year":"2013","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/00000658-198405000-00014","article-title":"Experience with vagotomy-antrectomy and Roux-en-Y gastrojejunostomy in surgical treatment of duodenal, gastric, and stomal ulcers","volume":"199","author":"Herrington","year":"1984","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1007\/s11605-023-05619-7","article-title":"Predictors of marginal ulcer after gastric bypass: A systematic review and meta-analysis","volume":"27","author":"Beran","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1097\/JS9.0000000000001042","article-title":"Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: A systematic review and meta-analysis of 14 cohort studies","volume":"110","author":"Liang","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1055\/s-0030-1256951","article-title":"Marginal ulceration after Roux-en-Y gastric bypass surgery: Characteristics, risk factors, treatment, and outcomes","volume":"43","author":"Azagury","year":"2011","journal-title":"Endoscopy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/SLA.0000000000001300","article-title":"Risk Factors for Marginal Ulcer After Gastric Bypass Surgery for Obesity","volume":"263","author":"Mattsson","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3047","DOI":"10.1007\/s00464-020-07669-3","article-title":"Smoking in bariatric surgery: A systematic review","volume":"35","author":"Chow","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.soard.2019.11.022","article-title":"Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: Analysis of the amount of daily and lifetime smoking on postoperative risk","volume":"16","author":"Dittrich","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.soard.2024.10.013","article-title":"American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery","volume":"21","author":"Vosburg","year":"2025","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.soard.2022.03.019","article-title":"Nonsteroid anti-inflammatory drugs and the risk of peptic ulcers after gastric bypass and sleeve gastrectomy","volume":"18","author":"Skogar","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1177\/00031348221103647","article-title":"Aspirin Use as a Risk Factor for Marginal Ulceration in Roux-en-Y Gastric Bypass Patients: A Meta-Analysis of 24,770 Patients","volume":"89","author":"Portela","year":"2023","journal-title":"Am. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.soard.2020.03.001","article-title":"Upper endoscopy after Roux-en-Y gastric bypass: Diagnostic yield and factors associated with relevant findings","volume":"16","author":"Boerlage","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s11695-023-06481-x","article-title":"Perioperative Interventions to Prevent Gastroesophageal Reflux Disease and Marginal Ulcers After Bariatric Surgery\u2014An International Experts\u2019 Survey","volume":"33","author":"Chiappetta","year":"2023","journal-title":"Obes. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/838\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T14:21:14Z","timestamp":1777472474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050838"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050838","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}