Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Dig Liver Dis. 2019 Oct;51(10):1375-1379. doi: 10.1016/j.dld.2019.04.010. Epub 2019 May 7.
Gastroesophageal reflux disease (GERD) is common in obese individuals. Prospective studies investigating validated GERD questionnaires and clinical parameters at identifying erosive esophagitis (EE) in this population are limited.
To prospectively evaluate the prevalence of GERD in obese patients considered for bariatric surgery and identify risk and predictive factors for EE.
Eligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy.
242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean BMI 40.4 ± 5.3 kg/m). The overall prevalence of gastroesophageal reflux (GERDQ ≥ 8, EE and/or PPI use) was 62.4%. EE was identified in 82 patients (33.9%) including 13/62 (21.0%) receiving PPIs at baseline. Multivariate logistic regression identified GERDQ ≥ 8 (OR = 6.3, 95%CI 3.0-13.1), hiatal hernia (OR = 4.2, 95%CI 1.6-10.7), abnormal Hill grade (OR = 2.7, 95%CI 1.4-5.4), and tobacco use (OR = 2.5, 95%CI 1.2-4.9) as independent risk factors for EE. A pre-endoscopic composite assessment including GERDQ ≥ 8 and presence of severe nocturnal reflux symptoms had 90% specificity and 20.7% sensitivity in identifying EE (NPV 68.9% and PPV 51.5%).
GERD is highly prevalent in obese patients. Anthropometric data and GERD questionnaires have limited accuracy at predicting erosive disease. Pre-operative endoscopic assessment in this population appears warranted.
胃食管反流病（GERD）在肥胖人群中很常见。针对该人群中经验证的 GERD 问卷和临床参数识别糜烂性食管炎（EE）的前瞻性研究有限。
前瞻性评估肥胖患者中 GERD 的患病率，并确定 EE 的风险和预测因素。
符合条件的患者在常规食管胃十二指肠镜检查前完成两份经过验证的问卷：GERDQ 和夜间症状严重程度影响（N-GSSIQ）。
共纳入 242 例连续患者（130 例女性；平均年龄 37.8±11.8 岁；平均 BMI 40.4±5.3kg/m2）。胃食管反流的总体患病率（GERDQ≥8、EE 和/或 PPI 使用）为 62.4%。在 82 例患者中发现 EE，其中 13 例/62 例（21.0%）基线时接受 PPI 治疗。多变量逻辑回归确定 GERDQ≥8（OR=6.3，95%CI 3.0-13.1）、食管裂孔疝（OR=4.2，95%CI 1.6-10.7）、异常 Hill 分级（OR=2.7，95%CI 1.4-5.4）和吸烟（OR=2.5，95%CI 1.2-4.9）是 EE 的独立危险因素。在识别 EE 方面，内镜检查前包括 GERDQ≥8 和存在严重夜间反流症状的综合评估具有 90%的特异性和 20.7%的敏感性（NPV 为 68.9%，PPV 为 51.5%）。
GERD 在肥胖患者中很常见。人体测量数据和 GERD 问卷在预测糜烂性疾病方面准确性有限。在该人群中进行术前内镜评估似乎是合理的。
