减重手术术后胃食管反流病的研究进展

减重手术做为目前治疗肥胖症有效术式,其安全和持久性得到了广泛的认可。其中腹腔镜袖状胃切除术(LSG)由于操作简单、不改变胃肠道结构、具有安全性高且疗效明显的优点,近年来做为主要的减重术式得到迅速普及应用。但肥胖症患者在行LSG术后,胃食管反流病发病率、疾病的转归、术中是否加做抗反流手术目前尚无统一意见。     

胃食管反流与反流性食管炎

胃食管反流(gastroesophageal reflux,GER)主要由于食管下端括约肌(lower esophagealsphincter,LES)松弛,引起胃内容物反流入食管下段。这种现象可属生理性,常于正常人餐后出现,但因反流量不多,时间短暂,反流物即被清除回至胃内,并不致病。当有 LES 功能不良,导致频繁的 GER,量多且较持久时,可损伤食管下段粘膜而形成反流性食管炎,并能产生食管溃     

腹腔镜手术治疗胃食管反流病

腹腔镜下抗反流手术是近年来治疗胃食管反流病的新方法,本重点讨论腹腔镜下治疗胃食管反流病的手术适应证,术前准备,手术方式及术中,术后的并发症和短期,长期的疗效情况。     

Barrett食管、反流性食管炎和非糜烂性胃食管反流病的反流物特点

目的应用食管24 h pH-阻抗(MII-pH)等检查方法,分析具有胃食管反流病(GERD)典型症状、并且食管MII-pH检查结果异常的GERD患者,比较分析其各亚型,即Barrett食管(BE)、反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者的胃食管反流特点。 方法入选具有典型胃食管反流症状(烧心/反流),并且食管24 h MII-pH检查结果异常的GERD患者,根据内镜检查结果分为BE、RE、NERD三组,收集患者24 h的食管pH-阻抗信息,应用SPSS16.0统计软件进行组间Mann Whitney检验、多因素方差分析,P< 0.05认为具有统计学差异。 结果共入组103例具有典型反流症状且MII-pH监测阳性的GERD患者,其中有15例BE患者、32例RE患者、56例NERD患者。三组患者的平均年龄、性别构成、以及BMI无显著差异性。将三组患者的各项胃食管反流指标数值进行Mann-Whitney检验,显示RE、BE患者的DeMeester评分、pH<4反流时间百分比、长反流周期数显著高于NERD患者,具有显著性差异。BE患者的反流周期数显著多于RE和NERD患者,具有显著性差异。阻抗相关指标在三组患者之间均没有统计学差异。 结论与NERD相比,酸反流对于RE和BE具有更重要的致病意义。     

反流性食管炎的临床研究

目的　探讨酸及胆汁反流在胃食管反流病 (GERD)中的发生情况及二者在GERD发病中的作用。方法　对 5 2例有反流症状的患者行内镜检查及 2 4hpH值和胆汁反流检测。结果　 5 2例受检者中 ,42例测得明显反流 ,其中混合反流占 5 9 5 % (2 5 /4 2 ) ,单纯反流仅占 40 5 % (17/4 2 )。在单纯反流中 ,以单纯酸反流为主 ,占 76 4% (13 /17) ;在混合反流中 ,以酸反流为主 ,反流程度较重 ,胆汁反流程度较轻 ;反流性食管炎在混合反流中的比例显著大于单纯酸反流 (P <0 0 5 ) ,且混合反流中的食管炎显著重于单纯反流 (P <0 0 5 ) ;反流症状发生的频率及严重程度与酸反流指数呈线性相关。结论　GERD中以混合反流为主 ;在混合反流及单纯反流中均以酸反流为主。酸反流和胆汁反流存在正性协同作用。酸反流是引起反流症状的主要原因     

反流性食管炎的临床特征分析

目的通过对14年间内镜诊断的反流性食管炎(RE)病例分析,探讨反流性食管炎的临床特征。方法收集1990年至2004年间经内镜诊断的反流性食管炎3851例,按LA分级系统分级,对其一般状况、临床症状、内镜表现以及部分患者进行的食管动力检测资料做回顾性分析。结果14年间RE占总胃镜检查人数的2.95%,而2000年至2004年间达4.25%。RE的男女性别比为3.4:1。近4年原发性RE发病年龄为(53.9±14.5)岁,其中A、B级者85.8%,C、D级者仅14.2%。RE患者行24 h食管pH、胆汁监测的pH<4时间百分比、光吸收值≥0.14时间百分比等均明显异常, 且在轻、重度患者间差异有统计学意义(P<0.05)。有反流症状者占67.23%。反流症状的发生率在轻、重度患者中无显著差异,但相对高龄、男性、合并消化性溃疡等在重度RE中的比例明显较高。结论反流性食管炎在近年来发病率有增高趋势,但仍以轻度RE为主,老年男性、合并消化性溃疡可能是发生重度RE的危险因素,酸反流、十二指肠胃食管反流在RE的发病中有重要作用。近年对反流症状识别率的提高有助于胃食管反流病的诊断。     

腹腔镜抗反流手术术后并发症的处理

目的探讨腹腔镜抗反流手术术后并发症的评估及处理方法。 方法回顾性分析2005年9月至2014年4月,新疆维吾尔自治区人民医院施行腹腔镜抗反流手术725例患者的临床资料,并对并发症患者进行治疗分析。 结果725例患者均成功完成食管裂孔疝修补＋胃底折叠术。术后并发症患者45例,其中吞咽困难21例,食管裂孔疝复发(折叠的胃底疝入胸腔)4例,症状复发14例,胃肠胀气综合征6例。随访6个月至9年,平均36.6个月。 结论腹腔镜抗反流手术并发症的发生率及其后果主要与术前评估、术者经验、围手术期饮食指导和患者的依从性相关。     

Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery

BackgroundGastroesophageal 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.ObjectiveTo prospectively evaluate the prevalence of GERD in obese patients considered for bariatric surgery and identify risk and predictive factors for EE.MethodsEligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy.Results242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean BMI 40.4 ± 5.3 kg/m²). 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%).ConclusionGERD 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.     

Laparoscopic surgery for reflux esophagitis and paraesophageal hernia.

BACKGROUND: Laparoscopic surgery has become the standard for treatment of several abdominal diseases. We analyzed our data on laparoscopic treatment of reflux esophagitis and paraesophageal hernia. METHODS: Twenty patients (mean age 61 y; 14 men) - 18 with reflux esophagitis and sliding hiatus hernia, and two with paraesophageal and sliding hernia - were operated on using laparoscopy between March 1999 and March 2001. All patients were investigated by upper GI endoscopy, barium study and routine pre-operative work-up. Nineteen patients underwent a modified Nissen fundal wrap along with repair of the diaphragmatic crura; one patient had only crural repair with no fundal wrap. RESULTS: All procedures were completed laparoscopically. The mean operating time was 140 min (range 90 to 240). Eighteen patients were discharged on the third postoperative day and two on the fifth day. One patient had perforation of intrathoracic part of the esophagus during passage of an esophageal bougie; he presented with empyema 10 days after discharge and was treated by intercostal drainage. There were no other complications. All patients have been followed up on an outpatient basis for 3 months to 2 years. All are presently off acid-suppressive therapy. Seventeen patients are free of symptoms; two patients have gas bloat-like symptoms and one has occasional grade I dysphagia. CONCLUSIONS: Laparosopic surgery is a safe and effective method of treating esophagitis and paraesophageal hernia.     

Laryngopharyngeal reflux in patients with reflux esophagitis

AIM： To assess the prevalence of laryngopharyngeal reflux （LPR） in patients with reflux esophagitis and disclose factors contributing to the development of LPR.
METHODS： A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled. They received laryngoscopy to grade the reflux findings for the diagnosis of LPR. We used validated questionnaires to identify the presence of laryngopharyngeal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.
RESULTS： The prevalence rate of LPR in studied subjects with reflux esophagitis was 23.9%. Age, hoarseness and hiatus hernia were factors significantly associated with LPR. In 23 patients with a hiatus hernia, the group with LPR was found to have a lower trend of esophagitis grading.
CONCLUSION： Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagitis. The importance of hiatus hernia deserves further study.     

埃索美拉唑治疗反流性食管炎的疗效观察

质子泵抑制剂（PPI）是目前治疗反流性食管炎（RE）最有效的药物之一，埃索美拉唑是新一代PPI，其控制胃酸分泌的能力比其它PPI作用更强、更快，且持续时间更长，用于治疗RE取得较好的临床效果。本研究旨在通过比较埃索美拉唑与兰索拉唑治疗RE的疗效，探索埃索美拉唑治疗RE的临床应用价值。     

Effect of sucralfate on gastroesophageal reflux in esophagitis

Gastroesophageal reflux was assessed in 18 patients with endoscopically and histologically verified esophagitis, and 15 asymptomatic normal subjects, by a portable receiving system. The qualitative evaluation of the frequency of reflux episodes, normalized mean pH, normalized mean [H+] and the acid clearance rate is found to be indicative of gastroesophageal reflux. Twelve weeks of treatment with sucralfate in an open clinical trial resulted in a significant reduction of gastroesophageal reflux and the elimination of esophageal mucosal damage. Barrett++'s epithelium was found in a rather high proportion and proved to be resistant to treatment. It is suggested that the observed improvement is due to the barrier protecting properties of sucralfate restoring the motor function of the distal esophagus.     

洛赛克治疗返流性食管炎的疗效观察

返流形食管炎 (ｒｅｆｌｕｘｅｓｏｐｈａｇｉｔｉｓ ,ＲＥ)与食管、胃、十二指肠因素的关系已有阐述[1] ,根据上述理论 ,我院应用洛赛克治疗ＲＥ ,并以雷尼替丁为对照 ,对比观察近期疗效 ,现报道如下 :临床资料与方法40例返流性食管炎病人 ,为我院 2 0 0 1年 8月～ 2 0 0 2年 4月门诊诊治病人 ,均经胃镜及组织活检确诊。随机分为治疗组及对照组 ,治疗组 2 0例 ,男 15例 ,女 5例 ,年龄 3 5～ 5 8岁 ,平均年龄 46.6岁 ;对照组 2 0例 ,男 16例 ,女 4例 ,年龄 3 5～ 5 7岁 ,平均年龄 47.2岁。两组在年龄、性别、职业、吸烟史、饮酒史、症状及胃…     

有关反流性食管炎问题的再思考

我国对胃食管反流病 (GERD)的研究起步较晚,自 1999年 8月烟台制定了反流性食管病 (炎 )诊断及治疗试行方案以来,受到消化界的关注。全国许多医疗单位按照这一方案,对反流性食管炎 (RE)及相关课题,如 Barrett食管 (BE)、 RE及 BE与幽门螺杆菌 (Hp)感染、 RE与 BE随访等,已经或正在进一步研究;在此前,国内有关专著和专题论文发表了不少。现就个人认为一些与 GERD及 RE有关值得思考的问题,借本期重点号提出来供同道们思索、参考。 　　一般认为 RE患者中的肥胖和老年人较多,但老年与中、青年患者在发病上究竟有无差别 ?这…     

Complications of bariatric surgery: Dumping syndrome,reflux and vitamin deficiencies

Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.