Hong Dennis, Khajanchee Yashodhan S, Pereira Natasha, Lockhart Barbara, Patterson Emma J, Swanstrom Lee L
Bariatric Surgery Program and Minimally Invasive Surgery Program, Department of Surgery, Legacy Health System, 1040 NW 22nd Avenue, Portland, OR 97210, USA.
Obes Surg. 2004 Jun-Jul;14(6):744-9. doi: 10.1381/0960892041590854.
Obesity is an epidemic in the USA. Many disorders are associated with obesity including gastroesophageal reflux disease (GERD). However, the prevalence of GERD and esophageal motility disorders in the morbidly obese population is unclear.
During evaluation for bariatric surgery, 61 morbidly obese patients underwent preoperative 24-hr pH and esophageal manometry. A single reviewer evaluated all 24-hr pH and manometric tracings. Johnson-DeMeester score >14.7 was considered diagnostic of GERD. Manometric criteria for motility disorders were from published values. All values are given as mean +/- SD.
Mean age was 44.4 + 10.3 years. 55 of the patients (90%) were female. Mean BMI was 50.1 +/- 7.2 kg/m(2). 23 patients (38%) complained of GERD symptoms (reflux and/or heartburn). 1 patient (2%) complained of noncardiac chest pain. Mean Johnson-DeMeester score was 19.6 +/- 17.8. Mean intragastric and intrabolus pressures were both elevated (8.3 +/- 1.6 mmHg and 15 +/- 9 mmHg). 33 patients (54%) had abnormal manometric findings: 10 had a mechanically defective LES, 11 had a hypertensive LES, 2 had diffuse esophageal spasm, 3 had nutcracker esophagus,1 had ineffective esophageal disorder and 14 had nonspecific esophageal motility disorder. Some patients had more than one disorder. 20 patients (33%) had significantly elevated (>180 mmHg) contraction amplitudes at the most distal channel (210.0 +/- 28.7 mmHg).
Prevalence of manometric abnormalities in the morbidly obese is high. Presence of a nut cracker-like distal esophagus in the morbidly obese is significant and warrants further evaluation.
肥胖在美国是一种流行病。许多疾病都与肥胖有关，包括胃食管反流病（GERD）。然而，病态肥胖人群中GERD和食管动力障碍的患病率尚不清楚。
在对减肥手术进行评估期间，61例病态肥胖患者接受了术前24小时pH值监测和食管测压。由一名审阅者评估所有24小时pH值监测和测压记录。Johnson-DeMeester评分>14.7被认为可诊断为GERD。动力障碍的测压标准来自已发表的值。所有值均以平均值±标准差表示。
平均年龄为44.4±10.3岁。55例患者（90%）为女性。平均体重指数为50.1±7.2kg/m²。23例患者（38%）主诉有GERD症状（反流和/或烧心）。1例患者（2%）主诉非心源性胸痛。平均Johnson-DeMeester评分为19.6±17.8。胃内平均压力和团注平均压力均升高（分别为8.3±1.6mmHg和15±9mmHg）。33例患者（54%）测压结果异常：10例食管下括约肌机械性缺陷，11例食管下括约肌高压，2例弥漫性食管痉挛，3例胡桃夹食管，1例食管无效运动障碍，14例非特异性食管动力障碍。一些患者有不止一种疾病。20例患者（33%）在最远端通道的收缩幅度显著升高（>180mmHg）（210.0±28.7mmHg）。
病态肥胖人群中测压异常的患病率很高。病态肥胖患者中存在胡桃夹样远端食管很显著，值得进一步评估。
