The Durability of Laparoscopic Nissen Fundoplication: 11-Year Outcomes

Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure since its introduction in 1991. There are few studies with greater than 5-year outcomes. Herein we report a series of 312 consecutive patients who underwent primary LNF before 1996. Follow-up of more than 6 years was available in 166 patients, and the mean follow-up was 11 years (median 11.1 years, range 6.1–13.3 years). Prospective data collection included preoperative and current symptom scores (scale 0 = none to 3 = severe), as well as the level of patient satisfaction and use of antireflux medications. Total symptom score for each patient was summed from seven symptoms for a maximum value of 21. Heartburn and regurgitation were the most improved symptoms; however, all symptoms were significantly improved (P < 0.01). The total symptom score at follow-up was 2.6 down from 7.5 at baseline, with a mean difference of −4.9 (range −12 to 3). The percentage of patients stating they would have the procedure again was 93.3%, and 70% were off daily antireflux medications. Outcomes at a mean of 11 years after LNF are excellent, and the majority of patients had their symptoms resolved or significantly improved and are satisfied with their results. Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 22, 2006, Los Angeles, CA     

Pharmacologic management and treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in daily practice. Diagnosis can be made on symptom evaluation, on pH-monitoring or on endoscopic findings. In contrast to commonly held opinion there is no strong evidence that lifestyle factors are a dominant factor in the pathophysiology of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H(2)-blockers and proton pump inhibitors. This article gives an overview of the pharmacological management of GERD and focuses on the differential therapy of endoscopy-negative GERD, GERD with esophagitis and maintenance therapy.     

Gastroesophageal reflux disease is a progressive disease

It is controversial whether gastrooesophageal reflux disease represents a spectrum disease from a nonerosive to a complicated one, or whether it is a categorial disease, i.e. it can be divided into three categories, such as nonerosive gastrooesophageal reflux disease, erosive gastrooesophageal reflux disease and Barrett's esophagus (BE) with little or no transition from one category to the other. This controversy might be of general interest, because it has some implications in the management of the patient. However, literature data concerning the natural history of gastrooesophageal reflux disease are very limited, and in particular very few papers have dealt with the issue of describing the natural history of patients with nonerosive gastrooesophageal reflux disease. Aim of the present review is to reassess these scanty data, and to try to demonstrate that progression from milder to more severe forms of gastrooesophageal reflux disease is possible and documented.     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review

BackgroundSleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as 15–18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC).ObjectivesTo raise awareness of BE as a precancerous lesion which may progress toward malignancy after this popular bariatric procedure.SettingBariatric referral centers, Italy.MethodsAll patients referred to our bariatric center who developed an EAC after SG between 2012 and 2019 were reviewed and consecutively included in this study. The available scientific literature regarding this complication is additionally reviewed.ResultsThe 3 male patients comprised in this case series underwent laparoscopic SG between 2012 and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21–54 years and 43.1–75.6 kg/m², respectively. All patients were lost to follow-up early after surgery (3.7 ± 1.4 months), and were diagnosed with EAC at a mean of 27.3 ± 7.6 months after SG. The 4 reported cases in the scientific literature developed an EAC at a mean of 32.5 ± 23 months from SG. Overall, a diagnosis of EAC was made approximately 30.3 ± 17.1 months postoperatively, which seems relatively and worryingly early after surgery.ConclusionAlthough the rate and probability of progression from BE to EAC is still not well defined, assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then the preoperative identification and stratification of cancer risk factors in this subset of patients is strongly encouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diagnosis and for epidemiologic data collection purposes.     

胃食管反流病中医诊疗研究进展

综述了近年来中医对胃食管反流病的诊断与治疗概况，认为目前本病还没有一个统一、公认的中医辨证分型方法和标准，临床医生常根据自身的经验来辨证分型、选方用药。今后需加强中医诊治胃食管反流病的客观化与标准化研究，进一步提高诊疗水平。     

Symptoms of Early Cancer Especially Barrett''''s Carcinoma

The incidence of the adenocarcinoma of the esophagus (AC) has been rising exponentiallyin the Western World within the last 30 years.The reasons for this increase are not yet understood.Massive and long lasting gastroesophageal reflux causes the Barrett's esophagus which is considered tobe a precaneerosis.Therefore early diagnosis and appropriate treatment of gastroesophageal reflux isessential for the prevention of this tumor.This makes heartburn the leading clinical symptom in thepatient's history.In patients with heartburn it is possible to early endoscopically diagnose a Barrett'sesophagus or adenocarcinoma of the esophagus.However only few patients with this increased risk receivean index-endoscopy.In clinical studies a high rate of early carcinomas could be found and could be treatedwith mueosectomie or ablation.The majority of patients with AC present with symptoms suggestive ofprogressed disease such as dysphagia or weight loss.The prognosis in patients in late disease stages are witha 5-year survival of only 30% far worse than in patients with early carcinoma (85%).However the earlysymptoms such as heartburn or regurgitation are unspecific and make an effective diagnostical strategydifficult.To optimize screening it would be beneficial to identify patients with high risk for the developmentof adenocarcinoina of the esophagus.     

经口食管-胃底套扎术治疗胃食管反流病20例

目的:探讨以反酸和烧心为主的胃食管反流病经口内镜下食管-胃底套扎术疗效。方法:对以反酸和烧心症状为主的20例胃食管反流病(GERD)患者,经经验性PPI治疗有效、24h食管pH监测、胃镜检查后,行经口食管-胃底套扎术治疗,随访观察疗效。结果:经口食管-胃底套扎术后14例(70%)48h内即见症状明显缓解,尤其以烧心症状为主者。随访12个月,治疗后症状评分明显下降,与治疗前比较,差异有统计学意义(表1).13例(65%)3～6个月逐渐停药,6例(30%)药物维持,药量明显减少,症状明显减轻,1例(5%)自觉症状无明显改善。治疗过程中无穿孔、出血等严重并发症,无死亡病例。结论:内镜下食管-胃底套扎术治疗对以反酸、烧心症状为主的GERD,大部分患者症状可迅速缓解,不需长期药物维持治疗,并维持症状减轻或消失。此操作方法经济、简单、微创、安全、见效快。