Pauwels A, Boecxstaens V, Broers C, Tack J F
Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.
Division of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Neurogastroenterol Motil. 2017 Aug;29(8). doi: 10.1111/nmo.13063. Epub 2017 Mar 20.
Laparoscopic Nissen fundoplication is a commonly performed antireflux surgery, after which reflux symptoms are well controlled, however, complications such as inability to belch or dyspeptic symptoms (mimicking those of functional dyspepsia [FD]) might occur. The aim of the study was to prospectively evaluate symptom pattern and underlying pathophysiological mechanisms in patients with post-Nissen dyspepsia.
Twenty-four patients (12 f, mean age 44.5±2.8 years) with post-Nissen dyspepsia symptoms, five patients (3 f, mean age 38.8±3.2 years) with post-Nissen dysphagia symptoms and 14 pre-fundoplication patients (3 f, mean age 42.1±2.5 years) were evaluated. Patients filled out a Rome II-based dyspepsia symptom severity score, performed a gastric emptying test, and a gastric barostat study was used to evaluate the function of the proximal stomach.
Upper abdominal bloating scores were higher in post-Nissen dyspepsia patients (P=.016) and symptoms of postprandial distress syndrome (PDS) were more present in post-Nissen dyspepsia patients compared to the other two groups (P=.07). Weight loss was significantly higher in the post-Nissen groups compared to the pre-fundoplication (P=.02). Gastric emptying rates were similar in the three groups. Gastric accommodation (GA) was significantly impaired in the post-Nissen dyspepsia group (dyspepsia -30[-86-83] vs dysphagia 163[148-203] vs pre-fundoplication 147[75-174] mL, P=.004) and the prevalence of patients with impaired GA was higher in the post-Nissen group (P=.007). Postprandial fullness was more prevalent in patients with impaired GA compared to those with normal GA (P=.01).
Patients with post-Nissen dyspepsia show a symptom pattern similar to that in FD patients with PDS, and the main underlying mechanism seems to be impaired gastric accommodation to a meal.
腹腔镜下尼氏胃底折叠术是一种常用的抗反流手术，术后反流症状能得到很好的控制，然而，可能会出现诸如无法嗳气或消化不良症状（类似于功能性消化不良[FD]）等并发症。本研究的目的是前瞻性评估尼氏术后消化不良患者的症状模式及潜在的病理生理机制。
对24例有尼氏术后消化不良症状的患者（12例女性，平均年龄44.5±2.8岁）、5例有尼氏术后吞咽困难症状的患者（3例女性，平均年龄38.8±3.2岁）和14例胃底折叠术前患者（3例女性，平均年龄42.1±2.5岁）进行评估。患者填写基于罗马II标准的消化不良症状严重程度评分表，进行胃排空试验，并采用胃压力测定研究评估近端胃的功能。
尼氏术后消化不良患者的上腹胀气评分更高（P = 0.016），与其他两组相比，尼氏术后消化不良患者的餐后不适综合征（PDS）症状更常见（P = 0.07）。与胃底折叠术前相比，尼氏术后组的体重减轻明显更高（P = 0.02）。三组的胃排空率相似。尼氏术后消化不良组的胃容纳功能（GA）明显受损（消化不良组为-30[-86 - 83]，吞咽困难组为163[148 - 203]，胃底折叠术前组为147[75 - 174] mL，P = 0.004），尼氏术后组GA受损患者的患病率更高（P = 0.007）。与GA正常的患者相比，GA受损的患者餐后饱腹感更普遍（P = 0.01）。
尼氏术后消化不良患者表现出与PDS型FD患者相似的症状模式，主要潜在机制似乎是进餐时胃容纳功能受损。
