Norman James, Politz Douglas, Lopez Jose, Boone Deva, Stojadinovic Alexander
Norman Parathyroid Center, Tampa, FL, USA,
World J Surg. 2015 Mar;39(3):706-12. doi: 10.1007/s00268-014-2876-5.
Gastroesophageal reflux disease (GERD) symptoms are commonly reported in primary hyperparathyroidism (pHPT). Although a calcium-mediated cause-and-effect relationship has been suggested, it remains unknown if parathyroidectomy improves GERD symptoms.
Over a 22-month period, 1,175 (39%) of 3,000 consecutive adult patients with pHPT and symptomatic GERD (on prescription reflux medications daily for ≥2 years) undergoing parathyroidectomy were entered into a prospective study. Standardized Frequency Scale for Symptoms of GERD (FSSG) questionnaire was used to assess symptoms before, 1 and 2 years after parathyroidectomy.
Daily prescription medication was used by 81%, while 19% used daily non-prescription drugs, both for a mean of 2.9 ± 0.7 years. GERD symptoms improved (26%) or resolved completely (36%) in 62% of patients (p < 0.0001 vs. preoperative baseline) 1 year after parathyroidectomy. Prescription medications for GERD decreased from 81% of enrolled patients to 26% (p < 0.0001) 12 months postoperatively, with 39% having complete symptom relief and taking no medications (p < 0.0001). Daily use of prescription GERD medications decreased to occasional over-the-counter drug use in 35% after parathyroidectomy (p < 0.0001). Mean FSSG scores decreased significantly postoperatively (pre-op: 18.0 ± 8.0 vs. post-op: 10.0 ± 5.0; p < 0.0001), with significant improvements in all 12 FSSG categories, including motility (pre-op: 7.3 ± 3.0 vs. post-op: 4.4 ± 3.0; p < 0.0001) and acid reflux symptoms (pre-op: 10.8 ± 5.0 vs. post-op: 5.9 ± 4.0; p < 0.0001). Symptomatic improvements were durable 2 years after parathyroidectomy.
Symptomatic GERD is common in pHPT. Parathyroidectomy provides significant, durable relief of both motility and acid reflux symptoms allowing discontinuation of prescription drug use for GERD in most (74%) patients providing yet another indication for parathyroidectomy in pHPT.
原发性甲状旁腺功能亢进症（pHPT）患者常出现胃食管反流病（GERD）症状。尽管有人提出存在钙介导的因果关系，但甲状旁腺切除术后GERD症状是否改善仍不清楚。
在22个月的时间里，对3000例连续接受甲状旁腺切除术的成年pHPT和有症状GERD（每日服用处方反流药物≥2年）患者中的1175例（39%）进行了一项前瞻性研究。采用标准化的GERD症状频率量表（FSSG）问卷评估甲状旁腺切除术前、术后1年和2年的症状。
81%的患者使用每日处方药物，19%的患者使用每日非处方药物，平均使用时间均为2.9±0.7年。甲状旁腺切除术后1年，62%的患者GERD症状改善（26%）或完全缓解（36%）（与术前基线相比，p<0.0001）。GERD的处方药物从入组患者的81%降至术后12个月的26%（p<0.0001），39%的患者症状完全缓解且不再服药（p<0.0001）。甲状旁腺切除术后，35%的患者从每日使用处方GERD药物减少为偶尔使用非处方药物（p<0.0001）。术后FSSG平均评分显著降低（术前：18.0±8.0，术后：10.0±5.0；p<0.0001），FSSG的所有12个类别均有显著改善，包括动力（术前：7.3±3.0，术后：4.4±3.0；p<0.0001）和酸反流症状（术前：10.8±5.0，术后：5.9±4.0；p<0.0001）。甲状旁腺切除术后2年，症状改善持续存在。
有症状的GERD在pHPT中很常见。甲状旁腺切除术能显著、持久地缓解动力和酸反流症状，使大多数（74%）患者停止使用GERD的处方药物，这为pHPT患者进行甲状旁腺切除术提供了另一个指征。
