Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese
Manometric abnormalities and gastroesophageal reflux disease in the morbidly obese
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DOI：
10.1381/0960892041590854
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发表时间：
2004-06-01
期刊：
影响因子：
2.9
通讯作者：
Swanstrom, LL
中科院分区：
文献类型：
--
作者：
Hong, D;Khajanchee, YS;Swanstrom, LL
背景：肥胖在美国是一种流行病。许多疾病与肥胖有关，包括胃食道反流病(GERD)。然而，GERD和食道动力障碍在病态肥胖人群中的患病率尚不清楚。方法：在减肥手术评估期间，61例病态肥胖患者在手术前进行了24小时pH和食道测压。一名审查员评估了所有24小时的pH和测压示踪。Johnson-DeMeester评分14.7分被认为是GERD的诊断。运动障碍的测压标准取自已公布的数值。所有数值均为平均+/-SD。结果：平均年龄44.4±10.3岁。55例(90%)为女性。平均BMI为50.1±7.2 kg/m(2)。23例患者(38%)有GERD症状(反流和/或烧心)。1例(2%)主诉非心源性胸痛。平均Johnson-DeMeester评分为19.6+/-17.8。平均胃内压和胃内压均升高(8.3+/-1.6毫米汞柱和15+/-9毫米汞)。33例(54%)患者有异常测压表现，其中机械性LES 10例，高血压LES 11例，弥漫性食道2例。食道痉挛3例，无效食道1例，非特异性食道动力障碍14例。一些患者有不止一种障碍。20例患者(33%)在最远端通道的收缩幅度(210.0+/-28.7 mm Hg)显著升高(-gt；180 mm Hg)。结论：病态肥胖者的血压异常发生率较高。在病态肥胖者中存在胡桃夹状的远端食道是重要的，需要进一步的评估。
Background: Obesity is an epidemic in the USA. Many disorders are associated with obesity including gastroesophageal reflux disease (GERD). However, the prevalence of GERD and esophageal motility disorders in the morbidly obese population is unclear.Methods: During evaluation for bariatric surgery, 61 morbidly obese patients underwent preoperative 24hr pH and esophageal manometry. A single reviewer evaluated all 24-hr pH and manometric tracings. Johnson-DeMeester score >14.7 was considered diagnostic of GERD. Manometric criteria for motility disorders were from published values. All values are given as mean +/- SD.Results: Mean age was 44.4 + 10.3 years. 55 of the patients (90%) were female. Mean BMI was 50.1 +/- 7.2 kg/m(2). 23 patients (38%) complained of GERD symptoms (reflux and/or heartburn). 1 patient (2%) complained of noncardiac chest pain. Mean Johnson-DeMeester score was 19.6 +/- 17.8. Mean intragastric and intrabolus pressures were both elevated (8.3 +/- 1.6 mmHg and 15 +/- 9 mmHg). 33 patients (54%) had abnormal manometric findings: 10 had a mechanically defective LES, 11 had a hypertensive LES, 2 had diffuse esophageal. spasm, 3 had nutcracker esophagus, 1 had ineffective esophageal disorder and 14 had nonspecific esophageal motility disorder. Some patients had more than one disorder. 20 patients (33%) had significantly elevated (>180 mmHg) contraction amplitudes at the most distal channel (210.0 +/- 28.7 mmHg).Conclusions: Prevalence of manometric abnormalities in the morbidly obese is high. Presence of a nutcracker-like distal esophagus in the morbidly obese is significant and warrants further evaluation.