Division of Gastroenterology and Center for Esophageal Diseases, Baylor University Medical Center, and the Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas, USA.
Curr Opin Gastroenterol. 2021 Jul 1;37(4):364-371. doi: 10.1097/MOG.0000000000000745.
Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed.
Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility.
Bariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.
肥胖的发病率正在迅速上升，减重手术已成为一种流行的治疗选择，可以降低肥胖人群的全因死亡率。胃食管反流病（GERD）和食管动力障碍在肥胖人群中很常见，减重手术对这些疾病的影响因所施行的减重手术类型而异。
由于腹腔镜可调胃束带术会加重 GERD 症状并导致食管动力障碍，其应用已有所减少。虽然腹腔镜袖状胃切除术（LSG）是最流行的减重手术类型，但由于 LSG 与 GERD 恶化有关，因此应进行全面的酸反流评估。针对 LSG 引起的 GERD 的新方法包括磁括约肌增强术和同时进行胃底折叠术。由于与其他类型的减重手术相比，LSG 术后 GERD 和动力障碍的发生率较低，因此对于患有 GERD 和食管动力障碍的肥胖患者，应考虑行 Roux-en-Y 胃旁路术。
减重手术可影响食管动力，并导致 GERD 恶化或发生。在进行减重手术前，应全面评估胃肠道症状，并考虑进行高分辨率测压和 pH 测试等正式检查。根据这些结果，应相应调整减重手术技术的选择，以改善临床结局。
