Post-Gastric Bypass Vitamin Therapy: How Compliant are Your Patients and who is Doing the Monitoring?

Abstract Background: Following gastric bypass surgery, micronutrient deficiencies are a well-documented complication. Emerging evidence suggest that the replacement of these micronutrients represent an integral part of postoperative care. It is unclear whether patient's compliance with this strict regimen is applicable in all patients, as only few studies have addressed this important issue. Patients and methods: This is a prospective case review of 235 consecutive patients who underwent laparoscopic gastric bypass between January 2005 and December 2009. All patients were instructed before surgery and during subsequent postoperative visits about compliance with vitamin supplementation. A telephone interview was conducted to assess compliance and frequency of vitamin lab draws. Laboratory records of responders were compared with their response. Results: 235 patients completed the interview. Mean age was 39 (range=20-60), male: female =16: 219. About 51% (n=119) of the patients had a managed government sponsored insurance, the remaining with commercial insurance. Only 25% (n=59) of the patients reported taking all recommended vitamin supplementation, while 10% (n= 23) reported not taking any nutritional supplements. A further 65% (n=153) were taking incomplete supplements. In the early postoperative period, compliance was over 90%. Most defaulters stopped their supplements after 12-18 months of their surgery on average. Constipation, forgetfulness and cost of medications were the most common reasons for stopping. Most patients (54%) obtained their laboratory tests from their primary care physician. Iron was the most common self-reported deficiency. Conclusion: Despite adequate patient's education, compliance with micronutrient supplementation remains a major problem in post gastric bypass patients.