Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations.
Gastro-oesophageal reflux disease in obesity: pathophysiological and therapeutic considerations.
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DOI：
10.1046/j.1467-789x.2002.00049.x
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发表时间：
2002-02-01
期刊：
影响因子：
--
通讯作者：
Sitrin, M D
中科院分区：
文献类型：
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作者：
Barak, N;Ehrenpreis, E D;Sitrin, M D
胃食管反流病（GERD）在肥胖患者中很常见。除了身体不适和经济负担外，胃食管反流还可能通过与食管癌的关联而增加发病率和死亡率。肥胖和瘦弱受试者的胃食管反流的病理生理不同。首先，肥胖受试者对食道中的酸更敏感。其次，裂孔疝可通过多种机制促进胃反流，在肥胖人群中更为普遍。第三，肥胖受试者腹部内压升高，移位下食管括约肌，增加胃-食管梯度。最后，与肥胖相关的迷走神经异常可能导致胆汁和胰腺酶的分泌增加，这使得反流对食管粘膜的毒性更大。与肥胖相关的身体成分改变会影响药物的药代动力学。没有关于任何用于治疗胃食管反流的药物疗效的数据。西咪替丁和雷尼替丁的剂量应根据患者的理想体重计算，而不是根据实际体重计算。在用于减肥的手术过程中，Roux-en-Y胃旁路术被发现对胃反流最有效，而胃束带术与反流的高发率相关。这篇综述概述了肥胖症中反流胃食管反流的病理生理学和治疗，并强调了这类患者的治疗考虑。
Gastro-oesophageal reflux disease (GERD) is common in obese patients. Apart from the physical discomfort and the economic burden, GERD may increase morbidity and mortality through its association with oesophageal carcinoma. The pathophysiology of GERD differs between obese and lean subjects. First, obese subjects are more sensitive to the presence of acid in the oesophagus. Second, hiatal hernia, capable of promoting GERD by several mechanisms, is more prevalent among the obese. Third, obese subjects have increased intra-abdominal pressure that displaces the lower oesophageal sphincter and increases the gastro-oesophageal gradient. Finally, vagal abnormalities associated with obesity may cause a higher output of bile and pancreatic enzymes, which makes the refluxate more toxic to the oesophageal mucosa. The altered body composition associated with obesity affects the pharmacokinetics of drugs. There are no data regarding the efficacy of any of the drugs used for GERD treatment. The dosages of cimetidine and ranitidine should be calculated according to the patient's ideal body weight, not their actual weight. Of the operative procedures used for weight loss, Roux-en-Y gastric bypass was found to be most effective for GERD, while gastric banding was associated with a high prevalence of reflux. This review outlines the pathophysiology and the treatment of GERD in obesity with emphasis on the therapeutic considerations in this population of patients.