Masqusi Suhair, Velanovich Vic
Division of General Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
World J Surg. 2007 Feb;31(2):332-6. doi: 10.1007/s00268-006-0723-z.
Although gastroparesis does not influence gastroesophageal reflux disease (GERD) or antireflux surgery, many patients with GERD will also suffer from gastroparesis-related bloating as a distinct symptom different from GERD-related symptoms. The purpose of this study was to assess whether a pyloroplasty with a fundoplication will improve bloating symptoms in these patients.
A prospectively gathered database of all patients undergoing antireflux surgery was reviewed. All patients underwent history, physical examination, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and, selectively, contrast upper gastrointestinal radiography. Patients with symptoms of bloating also underwent gastric emptying scintigraphy. All patients completed the GERD-Health Related Quality of Life (HRQL) symptom severity questionnaire. One of the items of this instrument relates to bloating. The item is scored from 0 (asymptomatic) to 5 (incapacitating) based on descriptive anchors. Patients with symptomatic GERD and objective findings by physiologic testing were offered antireflux surgery. Those with delayed gastric emptying (defined as T(1/2) > 120 minutes) were also offered a pyloroplasty. Operations performed included a laparoscopic or open Nissen or Toupet fundoplication with a Heineke-Mickulicz pyloroplasty. Postoperatively, patients completed the GERD-HRQL and had a gastric emptying scintigraphy performed.
Three-hundred and sixty-nine patients underwent antireflux surgery; of these, 35 patients also had a pyloroplasty. Twenty-eight (80%) of these patients reported significant symptomatic improvement. The median preoperative bloating score improved from 4 to 1 postoperatively (P < 0.05), and the median gastric emptying scintigraphy T(1/2) improved from 244 to 112 minutes (P < 0.05).
Although gastroparesis may not contribute to symptoms of GERD, it can contribute to symptoms of bloating. Bloating symptoms improved in 80% of patients with the addition of a pyloroplasty. Therefore, addition of pyloroplasty to a fundoplication in patients with gastroparesis-related bloating can improve bloating symptoms.
虽然胃轻瘫不影响胃食管反流病（GERD）或抗反流手术，但许多GERD患者也会出现与胃轻瘫相关的腹胀，这是一种与GERD相关症状不同的独特症状。本研究的目的是评估幽门成形术联合胃底折叠术是否能改善这些患者的腹胀症状。
回顾了一个前瞻性收集的所有接受抗反流手术患者的数据库。所有患者均接受了病史、体格检查、上消化道内镜检查、食管测压、24小时食管pH监测，并选择性地进行了上消化道造影。有腹胀症状的患者还接受了胃排空闪烁扫描。所有患者均完成了GERD健康相关生活质量（HRQL）症状严重程度问卷。该问卷的一项内容与腹胀有关。根据描述性锚定，该项目的评分从0（无症状）到5（失能）。有症状性GERD且经生理测试有客观发现的患者接受了抗反流手术。胃排空延迟（定义为T（1/2）>120分钟）的患者也接受了幽门成形术。所进行的手术包括腹腔镜或开放的nissen或Toupet胃底折叠术联合Heineke-Mickulicz幽门成形术。术后，患者完成GERD-HRQL并进行胃排空闪烁扫描。
369例患者接受了抗反流手术；其中35例患者还接受了幽门成形术。这些患者中有28例（80%）报告症状有显著改善。术前腹胀评分中位数从4改善到术后的1（P<0.05），胃排空闪烁扫描T（1/2）中位数从244分钟改善到112分钟（P<0.05）。
虽然胃轻瘫可能不会导致GERD症状，但它可能导致腹胀症状。在80%的患者中，加用幽门成形术后腹胀症状得到改善。因此，对于有胃轻瘫相关腹胀的患者，在胃底折叠术基础上加用幽门成形术可改善腹胀症状。
