Kamolz T, Granderath F, Pointner R
Division of Clinical Psychology, Public Hospital of Zell am See, Austria.
Surg Endosc. 2003 Jun;17(6):880-5. doi: 10.1007/s00464-002-9158-2. Epub 2003 Mar 7.
BACKGROUND: Several findings suggest that gastroesophageal reflux disease (GERD) has a significant impact on patients' quality of life. The aim of this prospective study was (a) to evaluate and compare quality-of-life data before and after laparoscopic antireflux surgery (LARS) in GERD patients with and without Barrett's esophagus (BE); and (b) to compare quality-of-life data of these patients to normative data for a comparable general population. METHODS: The Gastrointestinal Quality of Life Index (GIQLI) was administrated to 75 BE patients and to 174 patients with GERD without BE (Savary-Miller classification: grade 1: n = 49; grade 2: n = 69; grade 3: n = 56). The questionnaire was given to all patients preoperatively, 3months, 1 year, and 3 years after laparoscopic "floppy" Nissen fundoplication. RESULTS: Before surgery, BE patients (mean: 96.8 +/- 9.3 points) had a better but not significant (p<0.06) general score of the GIQLI when compared with patients without BE (mean: 86.4 +/- 10.1 points). This difference is solely based on the subdimension "gastrointestinal symptoms" which means that GERD symptoms are less intensively and frequently recognized in BE patients than in patients without BE. There are no other differences in the other four subdimensions of the GIQLI between both groups. Three months, 1 year, and 3 years after LARS, GIQLI was significantly (p<0.01) improved in both groups (BE patients mean after 3 years: 121.9 +/- 8.2 points; non-BE patients mean after 3 years: 122.8 +/- 9.3 points). This improvement was significantly better (p<0.05) in patients without BE than in BE patients. Before surgery, both groups scored significantly below average on all subscores of GIQLI compared to general population (mean: 122.6 +/- 8.5 points). After surgery, there are no differences detectable. CONCLUSION: As our data show, non-BE patients undergoing LARS achieve a better quality-of-life improvement than those patients with BE. However, after surgery GIQLI of both groups is comparable to the mean value of general population. This means that LARS is able to improve quality of life significantly in all GERD patients, with and without BE.
背景：多项研究结果表明，胃食管反流病（GERD）对患者的生活质量有重大影响。这项前瞻性研究的目的是：（a）评估和比较有和没有巴雷特食管（BE）的GERD患者在腹腔镜抗反流手术（LARS）前后的生活质量数据；（b）将这些患者的生活质量数据与可比的普通人群的标准数据进行比较。 方法：对75例BE患者和174例无BE的GERD患者（Savary-Miller分级：1级：n = 49；2级：n = 69；3级：n = 56）进行胃肠道生活质量指数（GIQLI）评估。在腹腔镜“松弛型”nissen胃底折叠术前、术后3个月、1年和3年向所有患者发放问卷。 结果：术前，BE患者（平均：96.8±9.3分）的GIQLI总体评分高于无BE患者（平均：86.4±10.1分），但差异不显著（p<0.06）。这种差异仅基于“胃肠道症状”子维度，这意味着BE患者的GERD症状不如无BE患者强烈和频繁。两组在GIQLI的其他四个子维度上没有其他差异。LARS术后3个月、1年和3年，两组的GIQLI均有显著改善（p<0.01）（BE患者3年后平均：121.9±8.2分；无BE患者3年后平均：122.8±9.3分）。无BE患者的改善明显优于BE患者（p<0.05）。术前，与普通人群相比，两组在GIQLI的所有子评分上均显著低于平均水平（平均：122.6±8.5分）。术后，未发现差异。 结论：正如我们的数据所示，接受LARS的无BE患者比有BE的患者生活质量改善更好。然而，术后两组的GIQLI与普通人群的平均值相当。这意味着LARS能够显著改善所有GERD患者的生活质量，无论有无BE。
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