Madalosso Carlos Augusto S, Gurski Richard Ricachenevsky, Callegari-Jacques Sidia M, Navarini Daniel, Mazzini Guilherme, Pereira Marina da Silva
*Department of Surgery, GASTROBESE, Passo Fundo, RS, Brazil †Hospital Universitário São Vicente de Paulo, Passo Fundo, RS, Brazil ‡Post-Graduate Program in Surgery, School of Medicine, UFRGS, Porto Alegre, RS, Brazil §School of Medicine, Hospital de Clinicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil ¶Department of Statistics, UFRGS, Porto Alegre, RS, Brazil ||School of Medicine, Universidade de Passo Fundo, Passo Fundo, RS, Brazil.
Ann Surg. 2016 Jan;263(1):110-6. doi: 10.1097/SLA.0000000000001139.
To assess the impact of Roux-en-Y gastric bypass (GBP) on gastroesophageal reflux disease (GERD) in morbidly obese patients.
Recently, authors have reported that early results of GBP can control GERD. However, longer follow-ups based on objective parameters for GERD are missing.
Fifty-three patients [15 men (28%), 39 years old (range, 18-59), body mass index = 46 ± 7.7 kg/m2] were consecutively evaluated for GERD irrespectively of related symptoms, before the operation (E1) and at 6 (E2) and 39 ± 7 months postoperatively (E3). The end points were (1) esophageal syndromes based on the Montreal Consensus and (2) an esophageal acid exposure assessment.
Body mass index dropped from 46 ± 7.7 kg/m2 at E1 to 30 ± 5.2 kg/m2 at E3. Typical reflux syndrome displayed a significant decrease from 31 (58%) at E1 to 8 (15%) at E2 and 5 (9%) at E3. Statistically significant differences occurred between E1 and both postoperative evaluations (P < 0.001). Reflux esophagitis was detected in 24 (45%), 17 (32%), and 10 patients (19%) at E1, E2, and E3, respectively (P = 0.002). The incidence of GERD decreased in 34 (64%) and 21 (40%) patients at E1 and E2, respectively, and then in 12 (23%) patients at E3. DeMeester scores reduced from 28.6 (E1) to 9.4 (E2) and 1.2 (E3) (P < 0.001).
For most morbidly obese patients, in addition to causing significant weight loss, GBP reduces GERD symptoms, improves reflux esophagitis, and decreases esophageal acid exposure for longer than 3 years.
评估Roux-en-Y胃旁路术（GBP）对病态肥胖患者胃食管反流病（GERD）的影响。
最近，有作者报道GBP的早期结果可控制GERD。然而，基于GERD客观参数的长期随访研究尚缺。
连续纳入53例患者[15例男性（28%），年龄39岁（范围18 - 59岁），体重指数 = 46 ± 7.7 kg/m²]，无论有无相关症状，在手术前（E1）、术后6个月（E2）及术后39 ± 7个月（E3）对GERD进行评估。观察终点为：（1）基于蒙特利尔共识的食管综合征；（2）食管酸暴露评估。
体重指数从E1时的46 ± 7.7 kg/m²降至E3时的30 ± 5.2 kg/m²。典型反流综合征从E1时的31例（58%）显著降至E2时的8例（15%）和E3时的5例（9%）。E1与术后两次评估之间均存在统计学显著差异（P < 0.001）。分别在E1、E2和E3时检测到反流性食管炎的患者有24例（45%）、17例（32%）和10例（19%）（P = 0.002）。GERD发病率在E1时下降的患者有34例（64%），E2时为21例（40%），E3时为12例（23%）。DeMeester评分从E1时的28.6降至E2时的9.4和E3时的1.2（P < 0.001）。
对于大多数病态肥胖患者，GBP除了能显著减轻体重外，还能减轻GERD症状，改善反流性食管炎，并在超过3年的时间里减少食管酸暴露。
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