Centre de Recherche sur l'Inflammation, Inserm UMRS 1149, Université de Paris, 75018, Paris, France.
Département d'Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France.
Obes Surg. 2021 Aug;31(8):3490-3497. doi: 10.1007/s11695-021-05427-5. Epub 2021 Apr 20.
Predictive factors of evolution or appearance of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) have not been identified to date. We aimed to assess the evolution of GERD symptoms 1 year after SG and to determine preoperative predictive factors using high-resolution manometry (HRM) and ambulatory 24-h esophageal pH monitoring (APM).
We included 160 patients who underwent SG between 2013 and 2017 and performed preoperative APM and HRM. Positive APM was defined according to the Lyon consensus. Symptoms of GERD, proton pump inhibitors (PPI) use, weight loss (WL), and diet were recorded in all patients before and 1 year after surgery.
One year after surgery, 58 patients (36.3%) complained of GERD symptoms compared to 52 patients (32.5%) preoperatively (p=0.48). Among patients with preoperative GERD symptoms, only 26/52 patients (50%) still had symptoms, whereas 32/108 (29.6%) asymptomatic patients developed de novo GERD symptoms after surgery. PPI use increased after surgery reaching 36.9% of patients against 15.0% before (p<0.0001). Only preoperative symptoms of GERD were predictive of postoperative symptoms (OR= 2.47 [1.14-5.45]; p=0.023) in multivariate analysis. Preoperative manometric parameters, postoperative diet, and WL were not related to postoperative symptoms. In asymptomatic patients before surgery, silent GERD (positive APM without symptom) was predictive of postoperative GERD symptoms (OR=2.69 [1.00-7.25]; p=0.049).
Evolution of GERD symptoms after SG reveals improvement for half of the patients and de novo GERD symptoms in one-third of patients. Predictive factors of postoperative symptoms are preoperative symptoms and positive preoperative APM in asymptomatic patients.
目前尚未确定袖状胃切除术（SG）后胃食管反流病（GERD）发生或出现的预测因素。我们旨在评估 SG 后 1 年 GERD 症状的演变，并使用高分辨率测压（HRM）和 24 小时食管 pH 监测（APM）确定术前预测因素。
我们纳入了 2013 年至 2017 年间接受 SG 的 160 名患者，并进行了术前 APM 和 HRM。阳性 APM 根据里昂共识进行定义。所有患者在术前和术后 1 年均记录 GERD 症状、质子泵抑制剂（PPI）使用、体重减轻（WL）和饮食情况。
与术前相比，术后 1 年时 58 例（36.3%）患者出现 GERD 症状，而 52 例（32.5%）患者出现 GERD 症状（p=0.48）。在术前有 GERD 症状的患者中，只有 26/52 例（50%）患者仍有症状，而在 108/108 例（29.6%）无症状患者中，有 32 例患者术后出现新的 GERD 症状。术后 PPI 使用增加，达到 36.9%的患者，而术前为 15.0%（p<0.0001）。仅术前 GERD 症状是术后症状的预测因素（OR=2.47[1.14-5.45]；p=0.023）。多变量分析显示，术前测压参数、术后饮食和 WL 与术后症状无关。在术前无症状的患者中，无症状性 GERD（无症状但 APM 阳性）是术后 GERD 症状的预测因素（OR=2.69[1.00-7.25]；p=0.049）。
SG 后 GERD 症状的演变显示出一半患者的症状改善，三分之一患者出现新的 GERD 症状。术后症状的预测因素是术前症状和无症状患者的术前 APM 阳性。
