袖子胃切除术后靠近胃的压缩与胃食道逆流有关
Garrett Greenan1, Benjamin D Rogers1,2, C Prakash Gyawali1
1Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri; USA.
The American journal of gastroenterology
|June 19, 2023
概括
袖子胃切除术 (SG) 与Roux-en-Y胃绕道 (RYGB) 相比,与更多的反流有关. 胃食管结 (EGJ) 功能受损和SG后的胃压力增加有助于胃食管逆流,特别是在应力演习期间.
科学领域:
- 腹部外科 腹部外科
- 胃肠病学 胃肠病学
- 胃食道逆流性疾病 胃食道逆流性疾病
背景情况:
- 袖子胃切除术 (SG) 与Roux-en-Y胃绕道术 (RYGB) 相比,与持续性或新发性胃食道逆流的发病率有关.
- 了解后SG反流背后的机制对于改善患者的治疗结果至关重要.
研究的目的:
- 通过使用高分辨率计量仪 (HRM) 调查近距离胃压缩模式.
- 确定这些模式与SG后反流的发生之间的关联.
主要方法:
- 一项比较研究包括接受了SG和RYGB的患者,以及有症状和无症状的对照组.
- 使用了高分辨率测量仪 (HRM) 和门诊pH阻抗监测.
- 分析包括传统的HRM指标,食管胃结 (EGJ) 压力,收缩积分 (EGJ-CI),酸暴露时间 (AET) 和反流病例数,在各种操作中测量胃内压力.
主要成果:
- 与RYGB患者相比,SG患者的酸暴露时间 (AET),反流病例数和基线胃内压力显著增加.
- 在高反流负担期间,在SG患者中观察到较低的跨EGJ压力梯度.
- 多变量分析显示,SG状态和低EGJ收缩积分 (EGJ-CI) 是增加AET和反流发作的独立预测因素.
结论:
- 损坏的EGJ屏障功能和SG后改变的靠近胃压力显著与胃食道逆流有关.
- 这些发现特别明显在生理应变机动期间,突出显示了后SG反流的潜在机制.
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