The Functional Gut Clinic, London, W1G 6NB, UK.
RefluxUK, London, UK.
Surg Endosc. 2021 Dec;35(12):7112-7119. doi: 10.1007/s00464-020-08229-5. Epub 2021 Jan 21.
Prior to antireflux surgery, most patients with symptoms of gastroesophageal reflux disease (GERD) have been taking long-term proton pump inhibitors (PPIs). PPIs have been shown to cause changes to the intestinal microbiota, such as small intestinal bacterial overgrowth (SIBO), which is characterised by symptoms of gas bloating. Patients undergoing antireflux surgery are not routinely screened for SIBO, yet many patients experience gas-related symptoms postoperatively.
Data from consecutive patients (n = 104) referred to a speciality reflux centre were retrospectively assessed. Patients underwent a routine diagnostic workup for GERD including history, endoscopy, oesophageal manometry and 24-h pH-impedance monitoring off PPIs. Intestinal dysbiosis was determined by hydrogen and methane breath testing with a hydrogen-positive result indicative of SIBO and a methane-positive result indicative of intestinal methanogen overgrowth (IMO).
60.6% of patients had intestinal dysbiosis (39.4% had SIBO and 35.6% had IMO). Patients with dysbiosis were more likely to report bloating (74.6% vs 48.8%; P = 0.01) and belching (60.3% vs 34.1%; P = 0.01). The oesophageal acid exposure time and number of reflux episodes were similar between dysbiosis and non-dysbiosis groups, but patients with dysbiosis were more likely to have a positive reflux-symptom association (76.2% vs 31.7%; P < 0.001), especially for regurgitation in those with SIBO (P = 0.01). Hydrogen gas production was significantly greater in patients with a positive reflux-symptom association for regurgitation (228.8 ppm vs 129.1 ppm, P = 0.004) and belching (mean AUC 214.8 ppm vs 135.9 ppm, P = 0.02).
The prevalence of intestinal dysbiosis is high in patients with GERD, and these patients are more likely to report gas-related symptoms prior to antireflux surgery. Independently, SIBO may be a contributory factor to refractory reflux symptoms and gas bloating in antireflux surgery candidates.
在进行抗反流手术之前，大多数胃食管反流病（GERD）症状患者长期服用质子泵抑制剂（PPIs）。PPIs 已被证明会引起肠道微生物群的变化，例如小肠细菌过度生长（SIBO），其特征是有气体膨胀的症状。接受抗反流手术的患者通常不会进行 SIBO 筛查，但许多患者术后会出现与气体相关的症状。
回顾性评估了 104 例连续就诊于专门反流中心的患者的数据。患者接受 GERD 的常规诊断检查，包括病史、内窥镜检查、食管测压和 PPI 停药后 24 小时 pH 阻抗监测。通过氢和甲烷呼气试验确定肠道菌群失调，氢阳性结果提示 SIBO，甲烷阳性结果提示肠道产甲烷菌过度生长（IMO）。
60.6%的患者存在肠道菌群失调（39.4%有 SIBO，35.6%有 IMO）。肠道菌群失调的患者更有可能报告腹胀（74.6%比 48.8%；P=0.01）和呃逆（60.3%比 34.1%；P=0.01）。菌群失调组和非菌群失调组的食管酸暴露时间和反流次数相似，但菌群失调组的反流症状关联阳性率更高（76.2%比 31.7%；P<0.001），尤其是 SIBO 患者的胃食管反流（P=0.01）。胃食管反流症状关联阳性的患者中，氢气生成量显著更高（228.8ppm 比 129.1ppm，P=0.004）和呃逆（平均 AUC 214.8ppm 比 135.9ppm，P=0.02）。
GERD 患者肠道菌群失调的发生率很高，这些患者在进行抗反流手术前更有可能报告与气体相关的症状。独立地，SIBO 可能是抗反流手术候选者难治性反流症状和气体膨胀的一个促成因素。
