Rigaud D, Merrouche M, Le Moël G, Vatier J, Paycha F, Cadiot G, Naoui N, Mignon M
Service de Gastroentérologie, CHU Bichat-Claude-Bernard, Paris.
Gastroenterol Clin Biol. 1995 Oct;19(10):818-25.
To study in morbid obesity the relationship between the degree of gastro-oesophageal reflux (GER) and the excess of body weight, or the related factors such as the energy intake or the fat distribution (waist-hip ratio).
In 20 morbid obese subjects (body weight: 125 +/- 32 kg) consulting in a weight-loss programme, anthropometric measurements, 3-hr oesophageal pHmetry, double isotope labelled meal for studying gastric emptying, study of gastric acid and pepsin secretions using PEG 4,000 as marker, and upper endoscopy were performed.
Nine out of the 20 patients had more than 10 GER per 3-hr period. Seven patients had at least one GER symptom per day. In 6 patients, pH was under 4 for more than 10% of the time. The total number of GER and the number of GER of more than 5 min duration were correlated to the body mass index (P = 0.016 and P < 0.05 respectively). The number of GER was also correlated to the android type of overweight (P < 0.03). These relationships persisted when sex, age, smoking, and obesity complications (such as diabetes) were taken into account. There was a positive correlation between the number of GER and energy and lipid intake (energy intake: 3,119 +/- 1,082 kcal/day; P < 0.003 for both). The degree of GER was positively related to basal acid output (P = 0.049), and to sham feeding-stimulated acid output (P = 0.05); it was negatively related to gastric emptying half time, but was not correlated with basal or stimulated pepsin output. A relationship was found between body mass index (BMI) and gastric emptying half time for solid (P = 0.002) and liquid phases (P = 0.001).
GER seems to be common in long lasting morbid obesity. The number of refluxes increased with waist/hip ratio, BMI and energy or fat intake. GER was also increased by decreased gastric emptying rate, which was in part determined by BMI. The real prevalence of GER in morbid obeses must be determined by a large prospective study.
研究病态肥胖患者胃食管反流（GER）程度与体重超重之间的关系，以及相关因素如能量摄入或脂肪分布（腰臀比）。
对20名参加减肥项目咨询的病态肥胖受试者（体重：125±32千克）进行人体测量、3小时食管pH监测、用双同位素标记餐研究胃排空、使用聚乙二醇4000作为标志物研究胃酸和胃蛋白酶分泌，以及上消化道内镜检查。
20名患者中有9名每3小时GER超过10次。7名患者每天至少有一次GER症状。6名患者pH值低于4的时间超过10%。GER总数和持续时间超过5分钟的GER次数与体重指数相关（分别为P = 0.016和P < 0.05）。GER次数也与男性型超重相关（P < 0.03）。当考虑性别、年龄、吸烟和肥胖并发症（如糖尿病）时，这些关系依然存在。GER次数与能量和脂质摄入呈正相关（能量摄入：3119±1082千卡/天；两者均P < 0.003）。GER程度与基础酸排量呈正相关（P = 0.049），与假饲刺激酸排量呈正相关（P = 0.05）；与胃排空半衰期呈负相关，但与基础或刺激胃蛋白酶排量无关。发现体重指数（BMI）与固体（P = 0.002）和液相（P = 0.001）胃排空半衰期之间存在关系。
GER在长期病态肥胖中似乎很常见。反流次数随腰臀比、BMI以及能量或脂肪摄入增加而增多。胃排空率降低也会增加GER，而胃排空率部分由BMI决定。病态肥胖患者中GER的实际患病率必须通过大型前瞻性研究来确定。
