THE IMPACT OF WEIGHT LOSS AFTER BARIATRIC SURGERY ON SLEEP & ESOPHAGEAL FUNCTION

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。肥胖一直被认为是胃食道反流病(GERD)的危险因素。多项研究表明，虽然有肥胖的GERD患者，但肥胖患者有症状的GERD的发生率并不高于正常体重对照组患者。此外，下食道括约肌压力(LESP)降低在肥胖者中并不比对照组更常见。最后，关于减肥是否能改善超重的GERD患者的症状，存在争议。病态肥胖症患者接受胃限制性减肥手术后成功减肥。目前使用的两种限制性手术是垂直带式胃成形术(VBG)和可调式腹腔镜带式(Lap-Band)。据报道，这些患者术后出现GERD和食道动力障碍。众所周知，肥胖(BMI&GT；35)是阻塞性睡眠呼吸暂停(OSA)的一个危险因素，在男性中更明显。这一关联涉及的因素仍在调查中。体脂分布、荷尔蒙差异以及最近瘦素水平被认为是肥胖的可能原因。瘦素缺乏被认为在其他相关的呼吸系统疾病中起作用，如肥胖、呼吸不足综合征。也有几项研究评估了GERD和睡眠障碍之间的联系。卧位被认为是GERD的一个因素，“反应性”的食道清除机制受到卧位的阻碍，在睡眠、快速眼动睡眠时不起作用。在这项提案中，研究人员旨在研究减肥手术后体重减轻对食道功能和睡眠的影响。主要目标如下：1)检验肥胖患者测压测量的食道动力较基线有变化的假设；2)检验24小时pH研究较基线的变化；3)检验GERD症状评分较基线的变化。二级目标如下：1)检测减肥手术后6个月和12个月的胃泌素、胃蛋白酶原、瘦素和Ghrelin是否与患者术前基线相比有变化；2)检测有和没有GERD症状的肥胖患者幽门螺杆菌状态的变化；3)检测LAP-Band手术前后肥胖患者夜间反流和睡眠障碍。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Obesity has been considered to be a risk factor for gastroesophageal reflux disease (GERD). Several studies have shown that while there are obese patients with GERD, the incidence of obese patients with symptomatic GERD was no greater than in a population of normal-weight control patients. In addition, reduced lower esophageal sphincter pressure (LESP) was not more common in the obese than in the controls. Finally, there is controversy about whether weight loss improves symptoms in patients with GERD who are overweight. Patients with morbid obesity who undergo gastric restrictive weight loss procedures are successful in losing weight. Two restrictive procedures in use are the vertical band gastroplasty (VBG) and the adjustable laparoscopic band (Lap-Band). GERD and esophageal motility disturbances have been reported post-operatively in these patients. It is also known that obesity (BMI >35) is a risk factor for obstructive sleep apnea (OSA), more significantly in males. The factors involved in this association are still under investigation. Body fat distribution, hormonal differences and, recently, leptin levels have been suggested as possible etiologies of obesity. Leptin deficiency has been suggested as playing a role in other related respiratory disorders, such as obesity hypoventilation syndrome. There have also been several studies assessing the association of GERD and sleep disturbances. Recumbent posture has been considered a factor in GERD and "reactive" esophageal clearance mechanisms are hindered by the recumbent posture and are inoperative during sleep, rapid eye movement sleep. In this proposal, the investigators aim to study the impact of weight loss after bariatric surgery on esophageal function and sleep. Primary goals are as follows: 1) test the hypothesis that obese patients will have a change from baseline in esophageal motility measured by manometry; 2) examine the change of 24-hour pH study from baseline; 3) examine the change of GERD symptoms score from baseline. Secondary goals are as follows: 1) examine if there are changes in gastrin, pepsinogen, leptin, and ghrelin six months and twelve months after bariatric surgery compared with patients' own baseline preoperatively; 2) examine the change of Helicobacter pylori status in obese patients with and without GERD symptoms; 3) examine nocturnal reflux and sleep disturbances in obese patients pre and post Lap-Band surgery.