Change in gastrointestinal symptoms over the first 5 years after bariatric surgery in a multicenter cohort of adolescents
Change in gastrointestinal symptoms over the first 5 years after bariatric surgery in a multicenter cohort of adolescents
复制标题
DOI：
10.1016/j.jpedsurg.2019.02.032
复制
发表时间：
2019-06-01
影响因子：
2.4
通讯作者：
Inge, Thomas
中科院分区：
文献类型：
--
作者：
Dewberry, Lindel C.;Khoury, Jane C.;Inge, Thomas
背景：Roux-en-Y胃旁路术（RYGB）和垂直袖胃切除术（VSG）对重度肥胖青少年体重减轻有效。然而，对青少年手术后不良胃肠道症状（GIS）知之甚少。目的是检查手术后5年以上的GIS和不同手术类型的差异。方法：我们前瞻性研究了228名接受减肥手术的青少年（161名RYGB， 67名VSG）。术前、术后6个月及术后每年至5年评估胃肠道症状。对症状严重程度进行二分类分析。术后症状分析采用线性模型调整基线症状、BMI、早期术后并发症、性别和种族。结果：手术参与者年龄17 +/- 1.6岁，术前BMI 53 +/- 9.4 kg/m(2)。从6个月到5岁，胃食管反射症状（GERS）、恶心、腹胀和腹泻增加。术后6个月，ger的粗患病率从4% （1% RYGB, 11% VSG）增加到14% （10% RYGB, 26% VSG）。在校正分析中，与RYGB相比，VSG组发生GERS的几率要高4倍（4.85 95% CI 2.63, 8.91, p < 0.0001）。结论：与接受RYGB的青少年相比，接受VSG的青少年发生GERS的风险更高。接受VSG的青少年术前应告知GERS，术后应客观监测胃食管反流情况。临床试验注册：ClinicalTrials.gov，标识符：NCT00474318， https://clinicaltrials.gov/ct2/show/NCT00474318?term=Teen-LABS&rank=1.Type研究：治疗研究。(C) 2019 Elsevier Inc.版权所有。
Background: Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are effective for weight loss in adolescents with severe obesity. However, little is known about adverse gastrointestinal symptoms (GIS) following these operations in adolescents. The objective was to examine GIS over 5 years after surgery and differences by surgery type.Methods: We prospectively studied 228 adolescents (161 RYGB, 67 VSG) undergoing bariatric surgery. Gastrointestinal symptoms were assessed before surgery, at 6-months, and yearly to 5 years after surgery. Symptom severity was dichotomized for analysis. Analysis of post-surgery symptoms involved linear models adjusting for baseline symptoms, BMI, early post-operative complication, sex, and race.Results: Participants at surgery were 17 +/- 1.6 years with preoperative BMI 53 +/- 9.4 kg/m(2). From 6 months to 5 years, gastroesophageal reflex symptoms (GERS), nausea, bloating, and diarrhea increased. Crude prevalence rates of GERS increased from 4% (1% RYGB, 11% VSG) at 6-months post-surgery to 14% (10% RYGB, 26% VSG) at 5-years. In adjusted analyses, the VSG group experienced 4-told (4.85 95% CI 2.63, 8.91, p < 0.0001) greater odds of GERS compared to RYGB.Conclusions: Adolescents who underwent VSG experienced greater risk of GERS compared to those undergoing RYGB. Adolescents undergoing VSG should be counseled preoperatively about GERS and objectively monitored postoperatively for gastroesophageal reflux when indicated.Clinical trial registration: ClinicalTrials.gov, Identifier: NCT00474318, https://clinicaltrials.gov/ct2/show/NCT00474318?term=Teen-LABS&rank=1.Type of Study: Treatment Study. (C) 2019 Elsevier Inc. All rights reserved.