病态肥胖中的胃食管反流病：Roux-en-Y胃旁路手术的效果
Gastroesophageal reflux disease in morbid obesity: the effect of Roux-en-Y gastric bypass.
作者信息
Mejía-Rivas Mariel A, Herrera-López Alejandro, Hernández-Calleros Jorge, Herrera Miguel F, Valdovinos Miguel A
机构信息
Gastroenterology and Surgery Departments, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga # 15, Col. Sección XVI, Tlalpan, Mexico City, Mexico.
出版信息
Obes Surg. 2008 Oct;18(10):1217-24. doi: 10.1007/s11695-008-9474-2. Epub 2008 May 30.
BACKGROUND
Gastroesophageal reflux disease (GERD) is a common condition in obesity. The impact of Roux-en-Y gastric bypass (RYGBP) on GERD is poorly known. We studied the effect of the RYGBP on GERD in patients with morbid obesity (MO).
METHODS
Twenty consecutive patients with MO (BMI > 40 kg/m(2)) were studied before and 6 months after RYGBP. GERD symptoms were evaluated with Carlsson-Dent questionnaire (CDQ). All the patients underwent esophageal manometry and ambulatory 24-h pH-metry. Chi-square test was used to compare categorical variables, and Wilcoxon test was used for numerical variables. A p value under 0.05 was considered significant.
RESULTS
There were 16 women (80%) and 4 men (20%) with mean age 38.9 +/- 6.9 years included in this study. BMI was 48.5 +/- 6.2 kg/m(2) and 33.2 +/- 4.5 kg/m(2) before and after RYGBP, respectively. Mean weight reduction was 42.5 +/- 9.7 kg (p < 0.001). Reflux symptoms measured by CDQ and esophageal acid exposure improved significantly after RYGBP. The percentage of time of pH < 4 was 10.7 +/- 6.7 before and 1.6 +/- 1.2 after the surgical procedure (p < 0.001). LES basal pressure before and after the RYGBP was 18 +/- 11 and 20.1 +/- 5.6 mmHg (p = 0.372), and the esophageal body amplitude was 104.2 +/- 47.2 and 75.1 +/- 36.2 mmHg, respectively (p = 0.005).
CONCLUSION
RYGBP improves GERD symptoms and reduces esophageal acid exposure in patients with MO.
背景
胃食管反流病（GERD）在肥胖人群中较为常见。 Roux-en-Y胃旁路术（RYGBP）对GERD的影响尚不清楚。我们研究了RYGBP对病态肥胖（MO）患者GERD的影响。
方法
连续纳入20例MO患者（BMI>40kg/m²），在RYGBP术前及术后6个月进行研究。采用卡尔森-登特问卷（CDQ）评估GERD症状。所有患者均接受食管测压和24小时动态pH监测。采用卡方检验比较分类变量，采用威尔科克森检验比较数值变量。p值<0.05被认为具有统计学意义。
结果
本研究纳入16名女性（80%）和4名男性（20%），平均年龄38.9±6.9岁。RYGBP术前和术后BMI分别为48.5±6.2kg/m²和33.2±4.5kg/m²。平均体重减轻42.5±9.7kg（p<0.001）。RYGBP术后，CDQ测量的反流症状和食管酸暴露情况显著改善。手术前后pH<4的时间百分比分别为10.7±6.7和1.6±1.2（p<0.001）。RYGBP术前和术后LES基础压力分别为18±11和20.1±5.6mmHg（p=0.372），食管体部振幅分别为104.2±47.2和75.1±36.2mmHg（p=0.005）。
结论
RYGBP可改善MO患者的GERD症状并减少食管酸暴露。
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