Wesp Julie A, Farrell Timothy M
Am Surg. 2018 Apr 1;84(4):501-505.
Epidemiological studies have demonstrated that obesity is frequently associated with esophageal motility disorders. Morbid obesity and achalasia may coexist in the same patient. The management of the morbidly obese patient with achalasia is complex and the most effective treatment remains controversial. The aim of this study is to review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of achalasia in morbidly obese patients.
PubMed search from January 1990 to July 2017, including the following terms: achalasia, morbid obesity, bariatric, and treatment. Achalasia in the setting of morbid obesity may be successfully treated by endoscopic or surgical methods. Surgeons may choose to add a bariatric procedure, with various strategies present in the literature. A review of the present literature suggests that the preferred approach to achalasia in the morbidly obese patient is to address both disease processes simultaneously with a laparoscopic Heller myotomy and a Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is cited by most experts as the bariatric procedure of choice, given its antireflux benefits. A well-powered study, comparing the various approaches to the treatment of achalasia in the setting of morbid obesity, is required to establish a consensus.
流行病学研究表明，肥胖常与食管动力障碍相关。病态肥胖和贲门失弛缓症可能在同一患者中并存。病态肥胖合并贲门失弛缓症患者的管理较为复杂，最有效的治疗方法仍存在争议。本研究的目的是回顾病态肥胖患者贲门失弛缓症的病理生理学、临床表现、诊断评估及治疗。
对1990年1月至2017年7月的PubMed进行检索，检索词包括：贲门失弛缓症、病态肥胖、减肥手术和治疗。病态肥胖情况下的贲门失弛缓症可通过内镜或手术方法成功治疗。外科医生可能会选择增加减肥手术，文献中有多种策略。对当前文献的综述表明，病态肥胖患者贲门失弛缓症的首选治疗方法是通过腹腔镜Heller肌切开术和Roux-en-Y胃旁路术同时处理这两种疾病过程。鉴于其抗反流益处，大多数专家将Roux-en-Y胃旁路术列为首选的减肥手术。需要进行一项有力的研究，比较病态肥胖情况下贲门失弛缓症的各种治疗方法，以达成共识。
