Department of General Surgery, University of Cologne, Cologne 50937, Germany.
Department of General Surgery, University of Mainz, Mainz D-55131, Germany.
World J Gastroenterol. 2019 Jan 21;25(3):388-397. doi: 10.3748/wjg.v25.i3.388.
The clinical presentation of gastroesophageal reflux disease (GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.
To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.
In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders [Somatoform Symptom Index (SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index (GIQLI).
In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48% (34 patients). Patients with a positive SSI had a preoperative GIQLI of 77 (32-111). Patients with a normal SSI had a GIQLI of 105 (29-140) ( < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI 102 (47-140) to postoperative values of 117 (44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75 (47-111) to postoperative 95 (44-122) ( < 0.0043).
Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.
胃食管反流病（GERD）的临床表现在不同患者之间也存在很大的症状差异，甚至强度也不同。正如多项研究所示，在经过证实的 GERD 与其他疾病（如消化不良、功能性烧心和/或躯体形式障碍）之间的症状谱存在很大重叠。
前瞻性评估腹腔镜抗反流手术后伴有和不伴有躯体形式障碍的 GERD 患者。
在一家三级胃食管外科转诊中心，对 3 年内符合腹腔镜抗反流手术指征的 GERD 患者进行前瞻性调查，以确定其症状谱，以确定 GERD 和相关的躯体形式障碍。采用躯体症状指数（SSI）>17 来评估症状。采用胃肠道生活质量指数（GIQLI）评估生活质量。
在 123 例患者中，确定了腹腔镜抗反流手术的适应证，在 43 例患者中建议进一步进行药物治疗。在总患者人群中，躯体形式倾向的比例为 20.48%（34 例）。SSI 阳性患者术前 GIQLI 为 77（32-111）。SSI 正常患者的 GIQLI 为 105（29-140）（<0.0001）。在 GERD 患者中，生活质量可以从术前 GIQLI 降低值 102（47-140）恢复到术后值 117（44-144）。在 GERD 和躯体形式障碍患者中，GIQLI 从术前 GIQLI 75（47-111）改善至术后 95（44-122）（<0.0043）。
伴有躯体形式障碍的 GERD 患者生活质量明显更差。后者也可以从腹腔镜胃底折叠术获益，但无法恢复到正常水平。
