What dosage of NSAIDs is safe to take after a gastric sleeve?

Dear Dr. Roach: I have had weight-loss surgery, specifically an adjustable lap band that was revised to a gastric sleeve in 2018. I have been given and read conflicting recommendations regarding the use of NSAIDs following these procedures. I have read that taking a low dose (400 mg) is considered safe. I have also read and been told to take the children’s liquid form at an adult dosage rather than the tablets.

I am a 57-year-old female. I have largely avoided taking NSAIDs for years, but I have developed osteoarthritis and find that I am taking them more often (400 mg once daily, one to two times a week at most). I do ensure that I take them with food and also take a Pepcid whenever I take ibuprofen.

A.W.

Answer: There are several types of weightloss (bariatric) surgery, and the best evidence I found among those who had a Roux-en-Y gastric bypass shows up to a 70% increase in relative risk of developing peptic ulcers after surgery. This sounds pretty terrible, but it actually means that in an average time span of four years after surgery, 1.4% of people who didn’t take any NSAIDs got an ulcer, while 2.4% developed an ulcer in the group that had the greatest amount of NSAID use. However, the same study showed that only 0.2% of patients who underwent a sleeve gastrectomy developed an ulcer, and the use of NSAIDs did not significantly increase this number.

Finally, other studies have shown that medicines like famotidine (Pepcid) reduce the risk of ulcers by about half when used long-term. NSAIDs always have risks, but for a person with a gastric sleeve, the risks of low-dose ibuprofen are modest and need to be weighed against the benefit for a person’s quality of life.

Dear Dr. Roach: My mother and one of her brothers had the flu in 1918. She talked about how very sick she was, but unlike her brother who was profoundly deaf from high fever, she experienced no aftereffects. She died at 90 without having the flu again or taking the yearly flu vaccine.

I am 83, have never had a flu shot and have never had the flu. I have had all the COVID-19 vaccines, but never the yearly flu shots. Could I have received immunity from her?

F.D.B.

Answer: No, you don’t get specific immunity from parents. Babies do get a type of “passive” immunity from their mothers, as antibodies are shared to the fetus through the placenta, but this only lasts weeks or months.

The 1918 influenza pandemic did leave survivors with very longlasting immunity to some types of the flu (like H1N1). Unfortunately, this immunity does not extend to other types of flu viruses, so I still recommend getting the yearly seasonal flu vaccines.

It’s my experience that when people tell me they have never had the flu, it’s not always true. Sometimes, the flu is mild and goes unrecognized. The flu is highly variable, and even young, healthy people with apparently good immune systems can succumb to the flu.

You may have inherited some of your mother’s apparently very robust immune system, as this is partially heritable. However, I wouldn’t depend on it entirely and do recommend the vaccine to help your immune system reduce your risk of severe flu. People over 65 may get a special, higherpotency flu vaccine.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.