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

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 肥胖被认为是胃食管反流病（GERD）的危险因素。 几项研究表明，虽然存在肥胖GERD患者，但肥胖患者伴症状性GERD的发病率并不高于正常体重对照患者。此外，肥胖组食管下括约肌压力（LESP）降低并不比对照组更常见。 最后，对于体重减轻是否能改善超重GERD患者的症状存在争议。 患有病态肥胖症的患者接受胃限制性减肥手术可以成功减肥。 两种限制性手术是垂直带胃成形术（VBG）和可调节腹腔镜带（Lap-Band）。 据报告，这些患者术后出现GERD和食管动力障碍。 还已知肥胖（BMI >35）是阻塞性睡眠呼吸暂停（OSA）的危险因素，在男性中更显著。 这种关联所涉及的因素仍在调查中。 身体脂肪分布、激素差异以及最近的瘦素水平被认为是肥胖的可能病因。 瘦素缺乏已被认为在其他相关的呼吸系统疾病中发挥作用，如肥胖低通气综合征。 也有一些研究评估GERD和睡眠障碍的关联。 卧位被认为是GERD的一个因素，“反应性”食管清除机制受到卧位的阻碍，并在睡眠、快速眼动睡眠期间受到抑制。 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管功能和睡眠的影响。 主要目标如下：1）检验肥胖患者通过测压测量的食管动力将较基线发生变化的假设; 2）检查24小时pH研究较基线的变化; 3）检查GERD症状评分较基线的变化。 次要目标如下：1）检查与患者术前基线相比，减肥手术后6个月和12个月的胃泌素、胃蛋白酶原、瘦素和胃饥饿素是否有变化; 2）检查有和无GERD症状的肥胖患者中幽门螺杆菌状态的变化; 3）检查Lap-Band手术前后肥胖患者的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.