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find Keyword "胃食管反流" 40 results
  • Individualized Management of Severe Gastroesophageal Reflux Disease Secondary to Scleroderma: Case Study and Literature Review

    ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.

    Release date:2016-10-25 06:10 Export PDF Favorites Scan
  • Prevalence of Helicobacter Pylori in Patients with Barrett’s Esophagus:

    Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA+ strains in patients with and without Barrett’s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett’s esophagus. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 4.2.8. Results Nineteen studies were identified (16 case-controlled studies and 3 cohort studies). In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett’s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 (95%CI 0.40 to 0.79). The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 (95% CI 0.74 to 1.00). In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett’s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 (95%CI 0.77 to 1.61) and 1.10 (95%CI 0.32 to 3.83). When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett’s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease (OR 0.55; 95%CI 0.33 to 0.94). Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett’s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett’s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease (OR 0.81, 95%CI 0.68 to 0.98). When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett’s esophagus (OR 0.54; 95%CI 0.35 to 0.82), but not in those with short-segment Barrett’s esophagus (OR 0.72; 95%CI 0.43 to 1.20). Conclusion  This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett’s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett’s esophagus.

    Release date:2016-08-25 03:36 Export PDF Favorites Scan
  • 管状胃成形对预防食管癌切除术后胃食管反流的作用

    摘要: 目的 探讨管状胃成形对减轻食管癌切除术后胃食管反流症的作用。 方法 选取2006年7月至2007年6月收治的120例食管癌患者,按手术术式不同分为两组,管状胃手术组:男42例,女18例;中位年龄58岁;传统手术组:男44例, 女16例;中位年龄61岁。术后3个月行食管24 h pH 监测,将gt;5 min的反流次数、反流百分率、最长反流时间指标与正常人进行比较。 结果 传统手术组术后有明显反流症状26例(43.33%),管状胃手术组12例(20.00%)。传统手术组gt;5 min的反流次数、反流百分率和最长反流时间均大于正常人(t=2.826,Plt;0.05;t=2.212,Plt;0.05;t=2.951,Plt;0.05);管状胃手术组患者仅最长反流时间大于正常人(t=2.303,Plt;0.05);gt;5 min的反流次数、反流百分率和最长反流时间均短于传统手术组,差异有统计学意义(t=2.081,Plt;0.05;t=2.050,Plt;0.05;t=2.112,Plt;0.05)。 结论 管状胃成形能有效降低食管癌术后胃食管反流的发生率。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Motility Function of the Remnant Esophagus and lntrathoracic Stomach after Esophagectomy for Cancer

    Objective To investigate the effect on motility function of remnant esophagus and intrathoracic stomach after esophagectomy for esophageal and cardiac carcinoma. Methods Thirty nine patients with esophageal and cardiac carcinoma were divided into two groups according to surgical procedure. Group of anastomosis above aortic arch (n = 21): esophagogastrostomy was performed above the aortic arch in patients with esophageal carcinoma of the middle third; group of anastomosis below aortic arch(n= 18): esophagogastrostomy was performed below the aortic arch in patients with esophageal carcinoma of the low third and cardiac carcinoma. Six health volunteers without gastroesophageal reflux were recruited as control group. Esophageal manometry and upper alimentary tract roentgenography were performed in all patients. Results There was a high pressure zone at the anastomotic orifice in parts of patients of both anastomosis groups. The resting pressure of remnant esophagus was higher than that in control group (P〈0. 05), and similar to the resting pressure of intrathoracic stomach (P〉0. 05). There was no significant difference in resting pressure of remnant esophagus and intrathoracic stomach between two anastomosis groups (P〉0.05). The amplitude and number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch were significantly reduced in comparison with control group. The number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch was significantly lower than that of group of anastomosis below aortic arch (P〈0. 05). The motility in the body of intrathoracic stomach was not observed. Weak motor activity of the gastric antrum was observed with upper alimentary tract roentgenography after surgery and evidently recovered 1 year after surgery. Conclusions The resting pressure of remnant esophagus and intrathoracic stomach is not influenced by the site of anastomosis. Esophagogastric anastomosis at the upper thorax is likely to result in poor motility of remnant esophagus. The motor activity of intrathoracic stomach becomes weak after esophagectomy and then recovers gradually over time, hut still fail to return to normal level.

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 食管胃黏膜延长分层吻合的实验研究

    目的 探讨食管胃吻合抗胃食管反流、预防吻合口瘘及狭窄的术式. 方法 选杂种犬58条,随机分为实验组和对照组.实验组:31条犬,自贲门横断,食管黏膜延长1.5~2 cm;切除部分胃小弯,剥除大弯侧保留部分浆肌层,成形为宽3~3.5 cm、长4~5 cm黏膜管,行食管胃黏膜、肌层分层吻合.对照组:27条犬,用"深套叠"术式.于术后3~180天检测对比分析. 结果 两组突入胃内结构长度、肌层吻合口直径差别无显著性意义(Pgt;0.05),黏膜游离缘直径差别有显著性意义(P<0.01);实验组能耐受较高胃内压,胃与食管压力差两组差别有显著性意义(P<0.01);突向胃腔内结构厚度两组相差1倍以上;实验组成形黏膜血供良好,吻合口愈合及缝线脱落早于对照组. 结论 适当剥除肌层不引起黏膜缺血坏死; 成形黏膜瓣薄软, 具有良好的抗反流效果; 黏膜层密缝对合严密、愈合快, 能有效预防吻合口瘘的发生,不同平面吻合狭窄发生率低.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • Clinical Analysis of Laparoscopic Nissen Fundoplication for Hiatal Hernia in Elderly Patients

    ObjectiveTo present the safety and efficiency of laparoscopic Nissen fundoplication for hiatal hernia in elderly patients. MethodsClinical data of 35 elderly patients with hiatal hernia who underwent laparoscopic Nissen fundoplication in The Affiliated Hospital of Xuzhou Medical College between August 2013 and March 2014 was retrospectively analyzed. ResultsAll patients underwent laparoscopic Nissen fundoplication. The operation time was 72-minute in average (65-105 minutes) and intraoperative blood loss was 30 mL in average (10-120 mL). The mean value of postoperative hospital stay was 5-day (3-23 days). Patients' stomachs and esophagus were restored to normal position after surgery. No complication was noted except 2 patients had mild gastroesophageal reflux after operation, and 1 patient suffered from transient dysphagia after operation, all the symptoms subsided after conservative treatment. Afterwards, 33 of them achieved follow-up for 6 to 12 months (mean of 8.5 months), the other 2 patients were lost to follow-up. During the follow-up period, a questionnaire regarding to the criteria for Reflux Diagnostic Questionnaire (RDQ) score were conducted in the 33 patients, and the results showed that the symptoms including acid reflux, heartburn, chest pain, cough, dyspnea, lump sensation in the pharynx, and hoarseness were improved significantly in 6 months after operation (P<0.05), and no recurrence was found during the follow-up period. ConclusionLaparoscopic Nissen fundoplication is a safe operation for elderly patients with hiatal hernia, and it can achieve good clinical result.

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  • Clinical Study of Gastroesophageal Reflux and Gastric Emptying after Esophagectomy with Gastric Replacement Through Esophageal Bed

    Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, gt;5 min reflux frequency, the longest time of keep reflux, pHlt;4.00 total time and pHlt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (Plt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pHlt;4.00 of total time and pHlt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(Plt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.

    Release date:2016-08-30 06:16 Export PDF Favorites Scan
  • 胃食管吻合术后胃食管反流症状的特征与相关因素的关系

    目的 探讨胃食管吻合术后胃食管反流症状的特征与相关因素的关系,以降低胃食管反流的发生率。 方法 回顾性分析239例食管、贲门癌切除胃食管吻合术后胃食管反流症状及与吻合平面、胃镜下表现和吻合口狭窄的关系。 结果 108例出现胃食管反流症状,发生率45.2% (108/239) ,主动脉弓下胃食管反流症状的发生率大于主动脉弓上反流症状发生率(707% vs.318%, Plt;0.01). 影响生活的反流症状(≥6分)发生率为25.5%,主动脉弓下吻合反流症状程度较主动脉弓上吻合重(439% vs. 159%, Plt;0.01) 。胃镜RE分级0+I级、II+III级出现反流症状的发生率分别为41.7%(63/151)和500% (44/88) ,两者比较差异无统计学意义(χ2=1.541, P=0.214) ,反流症状的严重程度与RE分级无相关性(r=0080, P=0.276) 。在有症状的反流患者中吻合口狭窄发生率为37% (40/108) ,无症状的反流患者中未发现吻合口狭窄,两者比较差异有统计学意义(χ2=49.262, P=0.000) 。吻合口狭窄与有胃食管反流症状呈正相关(r=0.480,P=0048). 结论 食管胃吻合术后只有部分患者出现反流症状,主动脉弓下吻合反流症状多于主动脉弓上吻合,且程度较重。反流症状的严重程度及发生率与RE分级无关。吻合口狭窄与胃食管反流相关。

    Release date:2016-08-30 06:16 Export PDF Favorites Scan
  • Laparoscopic sleeve gastrectomy in combination with fundoplication for treatment of obesity accompanying gastroesophageal reflux disease

    ObjectiveTo summarize the mechanism of effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) and the research progress of LSG in combination with fundoplication on obesity with GERD. MethodThe literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed. ResultsAlthough there was considerable disagreement over the effect of LSG on GERD, the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD, which mainly due to the destruction of the lower esophageal sphincter, deactivation of His angle, elevated intragastric pressure, and shape of sleeve stomach. Currently, the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD. And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained, which needed to be evaluated by more studies and longer follow-up. ConclusionsThere is a risk of worsening existing GERD or promoting new GERD after LSG surgery. The LSG in combination with fundoplication is safe and feasible, which not only makes up for the adverse effects of LSG only on GERD after surgery, but also achieves the same similar effect of weight loss as LSG, providing a new choice for obese patients with GERD.

    Release date:2023-06-26 03:58 Export PDF Favorites Scan
  • Curative effect and prognosis of laparoscopic patch repair of esophageal hiatal hernia

    ObjectiveTo analyze the effect and prognosis of laparoscopic patch repair of esophageal hiatal hernia.MethodsFrom October 2014 to January 2019, 100 patients with gastroesophageal reflux disease undergoing laparoscopic esophageal hiatus hernia repair were randomly divided into the patch group and the non-patch group. All patients underwent laparoscopic repair of esophageal hiatal hernia plus fundoplication (Nissen’s method). On that basis, the patients in the patch group used special mesh for esophageal hiatal hernia repair, while the ones in the non-patch group did not. All the patients were followed up for a long time. The operative effect, postoperative complication rate, recurrence rate, and satisfaction rate of the patients between the two groups were compared.ResultsA total of 98 patients were successfully followed up for more than one year, including 68 in the patch group and 30 in the non-patch group. One year after surgery, the differences between the patch group and the non-patch group in the improvements of reflux attack, heartburn, dysphagia, and food intake were statistically significant (P<0.05); there was no significant difference between the patch group and the non-patch group in satisfaction rate (82.4% vs. 73.3%, P>0.05); the differences in recurrence rate (2.9% vs. 26.7%) and incidence of dysphagia (47.0% vs. 6.7%) between the patch group and the non-patch group were statistically significant (P<0.05).ConclusionFor the patients with gastroesophageal reflux disease caused by esophageal hiatal hernia, the laparoscopic repair of esophageal hiatal hernia + Nissen fundoplication on the basis of reasonable selection of special mesh for esophageal hiatal hernia can obtain satisfactory clinical effect.

    Release date:2020-04-23 06:56 Export PDF Favorites Scan
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