Coupaye Muriel, Gorbatchef Caroline, Calabrese Daniela, Sami Ouidad, Msika Simon, Coffin Benoit, Ledoux Séverine
Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, France.
Service de Gastroentérologie, Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, France.
Obes Surg. 2018 Mar;28(3):838-845. doi: 10.1007/s11695-017-2942-9.
Evolution of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) is controversial. Some authors report worsening or improvement of preoperative GERD, others the occurrence of de novo GERD between 5 and 69%.
The aims of this study are to evaluate the evolution of GERD after SG by ambulatory 24-h pH monitoring (APM) and to determine pre- and postoperative clinical and manometric factors associated with its evolution.
Between 2013 and 2015, 47 patients operated in our center performed APM before and 1 year (14.8 ± 4.9 months) after SG. GERD was defined as a percentage of time with esophageal pH < 4 (TpH < 4) > 4.2. Among them, 30 had pre- and postoperative high-resolution esophageal manometry (HRM).
Thirty-one patients (66%) had no preoperative GERD (group 1), and 16 had preoperative GERD (group 2). One year after SG, mean TpH < 4 increased significantly in group 1 (5.8 ± 4.6 vs. 1.8 ± 1.1%, p < 0.01) whereas it was not modified in group 2 (7.4 ± 6.6 vs. 6.6 ± 2.6%). In group 1, 16 patients (52%) had de novo GERD whereas in group 2, 7 had no more GERD, 3 improved, and 6 worsened. Maximal intragastric pressure after swallows increased significantly at postoperative HRM only in patients with de novo GERD (49.2 ± 22.0 vs. 25.4 ± 9.4 mmHg, p = 0.03). No preoperative clinical or manometric parameters were predictive of postoperative GERD.
One year after SG, esophageal acid exposure globally worsened, mostly because of de novo GERD, whereas 63% patients with preoperative GERD improved, without preoperative predictive clinical or manometric factor.
袖状胃切除术（SG）后胃食管反流病（GERD）的演变存在争议。一些作者报告术前GERD病情恶化或改善，另一些作者则报告新发性GERD的发生率在5%至69%之间。
本研究的目的是通过动态24小时pH监测（APM）评估SG术后GERD的演变，并确定与其演变相关的术前和术后临床及测压因素。
2013年至2015年间，在我们中心接受手术的47例患者在SG术前和术后1年（14.８±4.9个月）进行了APM。GERD定义为食管pH＜4（TpH＜4）的时间百分比＞4.2。其中，30例患者进行了术前和术后高分辨率食管测压（HRM）。
31例患者（66%）术前无GERD（第1组），16例患者术前有GERD（第2组）。SG术后1年，第1组平均TpH＜4显著增加（5.8±4.6 vs. 1.8±1.1%，p＜0.01），而第2组未改变（7.4±6.6 vs. 6.6±２.6%）。在第1组中，16例患者（52%）发生了新发性GERD，而在第2组中，7例患者不再有GERD，3例改善，6例恶化。仅在发生新发性GERD的患者中，术后HRM时吞咽后最大胃内压显著增加（49.2±22.0 vs. 25.4±9.4 mmHg，p =０.03）。术前临床或测压参数均不能预测术后GERD。
SG术后1年，食管酸暴露总体上恶化，主要是由于新发性GERD，而63%术前有GERD的患者病情改善，且无术前可预测的临床或测压因素。
