Naik Rishi D, Choksi Yash A, Vaezi Michael F
Dr Naik is a resident in internal medicine, Dr Choksi is a fellow, and Dr Vaezi is a professor and director of the Center for Swallowing and Esophageal Disorders in the Division of Gastroenterology, Hepatology, and Nutrition at Vanderbilt University Medical Center in Nashville, Tennessee.
Gastroenterol Hepatol (N Y). 2015 Dec;11(12):801-9.
Bariatric surgery has come to the forefront of weight loss treatment due to its complex interactions via anatomic, physiologic, and neurohormonal changes leading to sustained weight loss. Unlike lifestyle and pharmacologic options, which fail to show long-term sustained weight loss, bariatric surgery has been shown to decrease overall mortality and morbidity. Bariatric surgery can be purely restrictive, such as laparoscopic adjustable gastric band (LAGB) or laparoscopic sleeve gastrectomy (LSG), or restrictive-malabsorptive, such as Roux-en-Y gastric bypass (RYGB). These surgeries cause specific anatomic changes that promote weight loss; however, they also have unintended effects on the esophagus, particularly in terms of gastroesophageal reflux disease (GERD) and esophageal motility. Via restrictive surgery, LAGB has been widely reported to cause significant weight loss, although studies have also shown an increase and worsening of GERD as well as elevated rates of esophageal dilation, aperistalsis, and alterations in lower esophageal sphincter pressure. Along with LAGB, LSG has shown not only a worsening of GERD, but also the formation of de novo GERD in patients who were asymptomatic before the operation. In a restrictive-malabsorptive approach, RYGB has been reported to improve GERD and preserve esophageal motility. Bariatric surgery is a burgeoning field with immense implications on overall mortality. Future randomized, controlled trials are needed to better understand which patients should undergo particular surgeries, with greater emphasis on esophageal health and prevention of GERD and esophageal dysmotility.
由于减肥手术通过解剖学、生理学和神经激素变化产生复杂的相互作用，从而导致持续体重减轻，它已成为减肥治疗的前沿方法。与未能显示长期持续体重减轻的生活方式和药物选择不同，减肥手术已被证明可降低总体死亡率和发病率。减肥手术可以是单纯限制性的，如腹腔镜可调节胃束带术（LAGB）或腹腔镜袖状胃切除术（LSG），也可以是限制性-吸收不良性的，如Roux-en-Y胃旁路术（RYGB）。这些手术会引起特定的解剖学变化以促进体重减轻；然而，它们也会对食管产生意想不到的影响，尤其是在胃食管反流病（GERD）和食管动力方面。通过限制性手术，LAGB已被广泛报道可导致显著体重减轻，尽管研究也表明GERD会增加和恶化，以及食管扩张、蠕动消失和食管下括约肌压力改变的发生率升高。与LAGB一样，LSG不仅显示GERD恶化，而且在术前无症状的患者中还会出现新发GERD。在限制性-吸收不良性手术方法中，RYGB已被报道可改善GERD并保持食管动力。减肥手术是一个新兴领域，对总体死亡率有巨大影响。未来需要进行随机对照试验，以更好地了解哪些患者应接受特定手术，同时更加强调食管健康以及预防GERD和食管运动障碍。
