Obesity and GERD.
Obesity and GERD.
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DOI：
10.1016/j.gtc.2013.11.009
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发表时间：
2014-03
影响因子：
3.7
通讯作者：
Friedenberg F
中科院分区：
文献类型：
--
作者：
Chang P;Friedenberg F
流行病学资料显示，肥胖是胃食管反流病发生的重要危险因素。还有越来越多的数据表明，肥胖与长期反流相关的并发症有关，如糜烂性食管炎、巴雷特食管和食管腺癌。中心性肥胖，而不是BMI，似乎与这些并发症更密切相关。肥胖的病理生理障碍包括食管运动障碍、下食管括约肌异常、食管裂孔疝发展趋势、胃内压升高和胃容量增加。此外，脂肪细胞分泌脂联素和瘦素的改变被认为是肥胖与巴雷特食管和食管腺癌之间的联系。迄今为止的证据表明，减肥手术，特别是Roux-en-Y胃旁路手术，可以通过减轻多余的体重来改善反流病。手术数据被许多患者的食管裂孔疝合并修补术所混淆。医学减肥作为GERD治疗的数据不太可靠，但似乎与成功减肥和更少的GERD症状有关。
Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease. There is also accumulating data that obesity is associated with complications related to longstanding reflux such as erosive esophagitis, Barrett's Esophagus, and esophageal adenocarcinoma. Central obesity, rather than BMI, appears to be more closely associated with these complications. Pathophysiological disturbances in obesity include esophageal motor disorders, lower esophageal sphincter abnormalities, a trend toward the development of hiatal hernia, increased intragastric pressure and increased gastric capacity. Additionally, alterations in the secretion of adiponectin and leptin from adipocytes is a proposed link between obesity and Barrett's esophagus and esophageal adenocarcinoma. Evidence to date suggest that bariatric surgery, specifically Roux-en-Y gastric bypass, can ameliorate reflux disease through loss of excess weight. Surgical data is confounded by the concomitant repair of prevalent hiatal hernias in many patients. The data for medical weight loss as a treatment for GERD is less robust, but there does appear to be an association with successful weight loss and fewer GERD symptoms.
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