Carabotti Marilia, Avallone Marcello, Cereatti Fabrizio, Paganini Alessandro, Greco Francesco, Scirocco Annunziata, Severi Carola, Silecchia Gianfranco
Department of Internal Medicine and Medical Specialties, University of Rome "Sapienza", viale del Policlinico 155, 00161, Rome, Italy.
Department of Medical Surgical Sciences and Biotechnology, University of Rome "Sapienza", Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
Obes Surg. 2016 May;26(5):1075-80. doi: 10.1007/s11695-015-1861-x.
Before bariatric surgery, the necessity of routine upper gastrointestinal endoscopy is controversial, and guidelines recommend endoscopy in symptomatic cases. However, impaired visceral sensation occurring in obese patients may be misleading. The purpose of the study is to evaluate prospectively the prevalence of gastrointestinal symptoms, endoscopic findings, and the relation between symptoms and endoscopic findings in obese patients before surgery.
One hundred forty-two consecutive patients candidate to primary bariatric surgery filled out the validated Rome III symptomatic questionnaire and performed endoscopy.
With a median age of 41 years and BMI of 44 Kg/m(2), 83% were females. Symptoms were referred by 43% of patients: gastroesophageal reflux disease (GERD) (27.9%) and dyspepsia (24.6%), subdivided in postprandial distress (PDS) (66.7%) and epigastric pain (33.3%) syndromes. Of GERD patients, 19.7% presented concomitantly PDS. Belching was present in 8.2% and nausea and/or vomiting in 1.6% of patients. At endoscopy, one or more lesions were present in 47.1% of the patients: erosive esophagitis (5.6%), hiatal hernia (23.2%), gastroduodenal erosions (6.3%), and peptic ulcers (3.5%). At histology, 24% of patients have Helicobacter pylori infection, and its prevalence in gastroduodenal erosions and ulcers was 22.2 and 60%, respectively. Surprisingly, in patients with peptic lesions H. pylori-negative, no chronic use of NSAIDs was reported. Analyzing the coexistence of symptoms and lesions, these resulted equally distributed beyond the presence of symptoms, being present in 44.2 and 49.4% of symptomatic and asymptomatic patients, respectively.
The presence of symptoms cannot be considered as a valuable guide to indicate endoscopy since the majority of endoscopic lesions were asymptomatic and not H. pylori-related.
在减肥手术前，常规上消化道内镜检查的必要性存在争议，指南建议对有症状的病例进行内镜检查。然而，肥胖患者出现的内脏感觉受损可能会产生误导。本研究的目的是前瞻性评估肥胖患者术前胃肠道症状的发生率、内镜检查结果以及症状与内镜检查结果之间的关系。
142例连续接受初次减肥手术的患者填写了经过验证的罗马III症状问卷并进行了内镜检查。
患者中位年龄41岁，体重指数为44kg/m²，83%为女性。43%的患者有症状：胃食管反流病（GERD）（27.9%）和消化不良（24.6%），消化不良又分为餐后不适综合征（PDS）（66.7%）和上腹痛综合征（33.3%）。在GERD患者中，19.7%同时伴有PDS。8.2%的患者有嗳气，1.6%的患者有恶心和/或呕吐。内镜检查时，47.1%的患者有一个或多个病变：糜烂性食管炎（5.6%）、食管裂孔疝（23.2%）、胃十二指肠糜烂（6.3%）和消化性溃疡（3.5%）。组织学检查显示，24%的患者感染幽门螺杆菌，其在胃十二指肠糜烂和溃疡中的发生率分别为22.2%和60%。令人惊讶的是，在幽门螺杆菌阴性的消化性病变患者中，未报告长期使用非甾体抗炎药的情况。分析症状和病变的共存情况，结果显示无论有无症状，病变分布均无差异，有症状和无症状患者中分别有44.2%和49.4%存在病变。
症状的存在不能被视为指导内镜检查的有价值指标，因为大多数内镜病变无症状且与幽门螺杆菌无关。
