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1.
Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients, and a high body mass index (BMI) is
a risk factor for the development of GERD. However, the mechanism by which the BMI affects esophageal acid exposure is not
completely understood. Although many advances have been made in the understanding of the pathophysiology of GERD, many aspects
of the pathophysiology of this disease in morbidly obese patients remain unclear. The following review describes the current
evidence linking esophageal reflux to obesity, covering the pathophysiology of the disease and the implications for treatment
of GERD in the obese patient. 相似文献
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Obesity and gastroesophageal reflux disease (GERD) are prevalent in Western populations. In obese patients, high-resolution manometry often shows altered gastroesophageal pressure gradients, promoting retrograde gastric content flow into the esophagus and esophagogastric junction disruption, leading to a hiatal hernia. Hernia recurrence is higher in the obese, and recurrence is seen regardless of the operative approach used. Bariatric surgery is the gold-standard treatment for GERD in obese patients, and symptom improvement varies depending on the specific bariatric procedure performed, Roux-en-Y (RYGB), laparoscopic adjustable gastric banding (LAGB), or sleeve gastrectomy (SG). Studies have shown these surgeries significantly improve GERD, but RYGB had the greatest effect. Limited data is available examining the progression or regression of Barrett’s following bariatric surgery. We currently recommend RYGB for morbidly obese patients with Barrett’s esophagus. 相似文献
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Background Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective
effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after
antireflux surgery might be due to persistent postoperative reflux.
Methods A nationwide population-based case-control study in collaboration with 195 relevant Swedish hospital departments and tumor
registries during the study period 1995–1997. Frequency-matched control persons were randomly selected from the population
register. All study participants were personally interviewed regarding background data, exposures, symptoms, conditions, diseases,
surgery, and medications. Differences between cases and controls in the occurrence of daily, long-standing antireflux medication
5 years or later after antireflux surgery were estimated using Fisher’s exact test.
Results One hundred and eighty-nine out of 216 (88%) eligible cases of esophageal adenocarcinoma and 820 of 1,128 (73%) controls were
prospectively enrolled. Seven (3.7%) patients and 8 controls had undergone antireflux surgery at least 5 years before the
interview. All 7 case patients had Barrett’s mucosa. Four of the case patients had used postoperative antireflux medications
continuously (mean duration 10.2 years), while none of the control persons reported such use (P = 0.026). There was no difference in mean body mass index between patients with and without postoperative reflux (P = 0.81). No differences between the patients and controls were found regarding age, sex, body mass index, or tobacco smoking
status.
Conclusions Esophageal adenocarcinoma occurring late after antireflux surgery might at least partly be due to persistent postoperative
reflux. Further research is required to establish the role of antireflux surgery in the etiology of this tumor. 相似文献
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Leonardo Menegaz Conrado Richard Ricachenevsky Gurski André Ricardo Pereira da Rosa Aleksandar Petar Simic Sídia Maria Callegari-Jacques 《Journal of gastrointestinal surgery》2011,15(10):1756-1761
Introduction
The pathophysiology of gastroesophageal reflux disease is multifactorial, where esophageal motility is one of the factors implicated in its genesis. However, there is still no consensus on the existence of an association between esophageal dysmotility and hiatal hernia in patients with gastroesophageal reflux disease. The objective of this study was to establish the prevalence of esophageal dysmotility in patients with hiatal hernia and to determine if herniation is a factor related to esophageal dysmotility in patients with gastroesophageal reflux disease. 相似文献5.
《Surgical pathology clinics》2017,10(4):765-779
Esophagitis results from diverse causes, including gastroesophageal reflux, immune-mediated or allergic reactions, therapeutic complications, and infections. The appropriate clinical management differs in each of these situations and is often guided by pathologic interpretation of endoscopic mucosal biopsy specimens. This review summarizes the diagnostic features of unusual forms of esophagitis, including eosinophilic esophagitis, lymphocytic esophagitis, esophagitis dissecans superficialis, drug-induced esophageal injury, and bullous disorders. Differential diagnoses and distinguishing features are emphasized. 相似文献
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Rihn JA Kane J Albert TJ Vaccaro AR Hilibrand AS 《Clinical orthopaedics and related research》2011,469(3):658-665
Background
Existing studies suggest a relatively high incidence of dysphagia after anterior cervical decompression and fusion (ACDF). The majority of these studies, however, are retrospective in nature and lack a control group. 相似文献10.
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What Is Minimally Invasive Cardiac Surgery? 总被引:3,自引:0,他引:3
Vanermen H 《Journal of cardiac surgery》1998,13(4):268-274
Most patient concerns and demands for less invasive surgery are focused on comfort, cosmesis, and rehabilitation that are all related to the degree of invasiveness. The degree of invasiveness of cardiac surgery depends on two factors: the surgical approach--the length of the skin incision, the degree of retraction and aggression to the tissue, and the loss of blood--and the use of cardiopulmonary bypass. Regarding the surgical strategy, four categories of less invasive cardiac surgery can be distinguished: (1) direct coronary artery surgery via sternotomy on the beating heart (without extracorporeal circulation); (2) limited or modified approaches using conventional techniques and instruments with either conventional cardiopulmonary bypass or the EndoCPB endovascular cardiopulmonary bypass system; (3) minimally invasive direct coronary artery bypass on the beating heart via a parasternal or left anterior small thoracotomy; and (4) true Port-Access surgery in which all surgical acts are performed through ports and the heart is arrested with the Endoaortic Clamp catheter. These categories offer different advantages in terms of reducing invasiveness and may have different learning curves. Minimally invasive cardiac surgery is undergoing an explosive evolution, and although the indications and best strategies for the different categories are yet to be determined, the trend cannot be stopped. We try to distinguish between "fashionable" strategies and those that are truly revolutionary and investments in the future. 相似文献
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Background: We aimed to determine before Roux-en-Y gastric bypass (RYGBP) in asymptomatic morbidly obese patients: 1) the
prevalence of abnormal findings at upper gastrointestinal (UGI) endoscopy; 2) Helicobacter pylori (HP) status; 3) clinical consequences of these findings; and 4) associated costs. Methods: We retrospectively reviewed 468
consecutive patients, excluded those with UGI symptoms, drug intake or previous UGI endoscopy/surgery, and analyzed findings
in the 319 remaining patients (68%). Results: There were abnormal findings in 147 patients (46%), including 54 hiatal hernias
and 146 parietal (i.e. mucosal or submucosal) lesions. The most significant were 7 ulcers and 2 gastric polyposis. HP was
detected (using CLO-test) in 124 patients (39%). Histopathological examination of biopsies was abnormal in 109/161 patients
(68%), and disclosed mainly chronic gastritis (n=98). Abnormal findings were more frequent in HP-positive compared to HP-negative
patients (94 vs 51%, P<0.001). Findings had clinical implications in only 4% of patients: delayed surgery (7 ulcers), prophylactic gastrectomy (2
gastric polyposis), unnecessary work-up (3 irrelevant/false-positive diagnoses), and inclusion in a screening program (1 Barrett's
esophagus). Mean cost of complete UGI work-up was 389 €/patient. Conclusion: Asymptomatic morbidly obese patients frequently
harbour UGI lesions warranting UGI work-up before RYGBP. However, routine endoscopy presents drawbacks. We propose a less
invasive strategy which reduces costs and limits false-positive results and the subsequent investigations that they require.
In our series, it would have missed two gastric polyposis only, for which no formal recommendation has yet been issued. This
strategy could be a valuable alternative to routine UGI endoscopy before RYGBP in asymptomatic patients. 相似文献
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Toshitaka Hoppo Arul Immanuel Matthew Schuchert Zdenek Dubrava Andrew Smith Peter Nottle David I. Watson Blair A. Jobe 《Journal of gastrointestinal surgery》2010,14(12):1895-1901