Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.
Objective:To investigate the relationship between different endoscopic subtypes of gastroesophageal reflux disease and H. pylori infection.Methods:A total of 325 adult patients who were diagnosed as gastroesophageal reflux disease due to acid reflux and heartburn in our hospital from March 2021 to June 2022 and underwent gastroscopy were selected as the observation group, while 285 asymptomatic healthy persons who underwent gastroscopy during the same period were selected as the control group, and helicobacter pylori infection was compared between the two groups.?Meanwhile,the correlation between different subtypes of gastroesophageal reflux disease and helicobacter pylori infection was analyzed.Results:There were no significant differences in age, gender and body mass index between two groups. The Hp infection rate between the observation group and the control group was 52.6% and 56.1%, and there was no significant difference between the two groups (P>0.05). However, the Hp infection rate of the patients with reflux esophagitis was 41.9%, and the difference was statistically significant (P<0.05).?In the observation group, there were 122 cases of non-erosive esophagitis, 107 cases of grade A, 67 cases of grade B, 23 cases of grade C, 3 cases of grade D and 5 cases f Barrett's oesophagus.?The infection rates of Hp were 71.3%、52.3%、35.4%、17.4%、0/3和1/5, and there were significant differences among all groups (P<0.05).Conclusion:In patients with reflux esophagitis, the infection rate of Hp decreases with the increase of disease grade, which may delay the progression of the disease.However, there was no obvious correlation with its degree of infection.
Objective:To study the effects of Fuzheng Xiaowei Decoction on gastrointestinal motility and gastric mucosal repair in chronic atrophic gastritis (CAG) rats induced by N-Methyl-N'-nitro-N-nitrosoguanidine(MNNG).Methods:The rats were randomly divided into normal control group and modeling group, and the CAG rat model was established by MNNG combined with ethanol gavage. After modeling, the rats were randomly divided into model group, Fuzheng Xiaowei decoction low-dose, medium-dose and high-dose groups and enzyme group (10 rats per group). The low, medium and high dose groups of FuzhengXiaowei Decoction were given 0.74 g/kg, 1.48 g/kg and 2.22 g/kg by intragastric administration, respectively, and the vitase group was given 240?mg/kg intragastric administration of vitase, once a day for 6 w, and the gastric empting rate and small intestine propulsive ratio of rats were measured. The levels of gastrin (GAS), motilin (MTL) and somatostatin (SS) in rat serum and endothelin (ET), Prostaglandin E2 (PGE2), Secretory immunoglobulin A (sIgA) and glutathione (GSH) in rat gastric mucosa were determined by enzyme-linked immunosorbent assay (ELISA). The histopathological changes of gastric mucosa were detected by hematoxylin-eosin (HE) staining, and the apoptosis rate of gastric mucosal tissue was detected by Td-mediated dudpo-x nick end Labeling (TUNEL) staining. The protein levels of nuclear tran-scription factor 2 (Nrf2) and heme oxygenose 1 (HO-1) in gastric mucosa of rats were determined by Western blot.Results:Compared with the normal control group, the levels of serum GAS, SS, gastric emptier rate, intestinal propulsion ratio, PGE2, sIgA, GSH levels, Nrf2 and HO-1 protein levels of gastric mucosa in model group were significantly decreased (P<0.05). Serum MTL level, ET level and apoptosis rate of gastric mucosa tissue were significantly increased (P<0.05). Compared with model group, the serum GAS, SS levels, gastric emptying rate, small intestine advancement ratio, PGE2, sIgA, GSH levels, Nrf2 and HO-1 protein levels of gastric mucosa in FuzhengXiaowei Decoction and vitase group were significantly increased (P<0.05). Serum MTL level, ET level in gastric mucosa tissue and apoptosis rate of gastric mucosa tissue were significantly decreased (P<0.05), and the above indexes were more significantly changed with the increase of the dose of FuzhengXiaowei Decoction.Conclusion:Fuzheng Xiaowei Decoction can significantly regulate gastrointestinal hormone secretion, inhibit the apoptosis of gastric mucosa cells, promote the recovery of gastric motility, and repair the pathological changes of gastric mucosa in rats with chronic atrophic gastritis. The mechanism may be related to the regulation of Nrf2/HO-1 pathway.
Objective:To explore the mechanism of Mosapride in improving 5-hyd roxytryptamine metabolic pathway, gut bacteria and esophageal inflammation in mice under stress.Methods:8 week old SPF male mice were randomly divided into control, stress and mosapride intervention group (n=6); The mice in the stress and mosapride were restricted in the self-made restraint device for 2h every day and kept for 14 days period; The pathological changes of esophagus were observed by HE staining; tryptophan (TPH), tryptophan hydroxylase-1 (TPH-1), indoleamine 2,3 dioxygenase 1 (IDO-1), tryptophan 2,3 dioxygenase (TDO), canine uric acid (KYN), 5-HT,5-HT4R, F4/80, CD68 and inflammatory factors [interleukin-1 β (IL-1 β), toll-like receptor-4 (TLR-4), tumor necrosis factor-α (TNF-ɑ)] mRNA level were detected by RT-PCR; The 16s rRNA high-throughput sequencing technology was used to detect the intestinal flora of mice.Results:The mRNA expression levels of 5-HT and 5-HT4R were decreased in the stress group (P<0.001); Mosapride increased the mRNA levels of 5-HT and 5-HT4R (P<0.01). The mRNA level of enzymes (IDO-1, TDO, KYN) in 5-HT metabolic pathway was increased in the stress group (P<0.01, P<0.001); stress reduced the mRNA expression levels of TPH-1 and TPH (P<0.01, P<0.001); Mosapride intervention can improve the abnormal expression of 5-HT metabolic pathway enzymes induced by stress (P<0.01). The microbial diversity of mice in stress group was low; Mosapride intervention significantly improved the abnormal changes of Helicobacterceae, Alloprevotella and Lactobacillus in stress mice. Mosapride significantly inhibited the infiltration of esophageal mucositis induced by stress, and suppressed over expressions of immune cells (CD68, F4/80) and inflammatory factors(IL-1β, TLR-4, TNF-ɑ) (P<0.001).Conclusion:Mosapride can inhibit the occurrence of abnormal intestinal flora structure and esophageal inflammation induced by stress through regulating 5-HT metabolism.
Objective:To explore the effect of anxiety during proton pump inhibitor (PPI) treatment on the curative effect of gastroesophageal reflux disease (GERD).Methods:This study was a prospective cohort study. From January 2018 to December 2021, 503 patients who were diagnosed as GERD by gastroscopy and needed PPI treatment were collected. The main end point was effective treatment with proton pump inhibitor (PPI), and the follow-up time was 4 weeks. The patients were followed up by outpatient service, telephone and hospital medical records, and the occurrence of end point events and the detection of various indicators were counted. Patients were divided into two groups according to whether they were anxious or not, including 179 patients in anxiety group and 49 patients in non-anxiety group. Draw Kaplan-Meier survival curve to clarify the difference of effective rate after PPI treatment in different anxiety States, and use single-factor Cox regression model and multi-factor Cox regression model to clarify the relationship between anxiety and effective rate respectively, and at the same time use trend test to clarify the similarities and differences of different levels of anxiety on effective rate.Results:425 patients with GERD were finally included in this study. After 4-week follow-up, among 425 patients with GERD, 297 (69.88%) were effective after PPI treatment, and 128 (30.12%) were ineffective. Among 246 patients with anxiety, 160 patients (65.04%) were effective after PPI treatment, and 86 patients (34.96%) were ineffective. Among 179 patients without anxiety, 137 (76.54%) were effective after treatment, and 42 (23.46%) were ineffective. Patients without anxiety have a higher remission rate. The results of univariate and multivariate Cox regression analysis showed that no matter univariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05) or multivariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05), anxiety is a risk factor for reducing the curative effect of PPI; The trend test showed that with the increase of anxiety, the effective rate after PPI treatment decreased significantly (P for trend<0.05).Conclusion:Anxiety is a risk factor for refractory gastroesophageal reflux disease. Anxiety reduces the therapeutic effect of PPIs on GERD symptoms. Therefore, it is necessary to pay attention to detect the anxiety state of patients with GERD symptoms in order to treat patients appropriately and optimize the treatment results.
食管裂孔疝是常见病，会引起反酸烧心、反流性食管炎，甚至恶性呕吐、贫血及营养不良等并发症。腹腔镜食管裂孔疝修补术是治疗食管裂孔疝的有效方法。为了降低食管裂孔疝手术的复发率，通常采用补片来加强膈肌角和食管裂孔，但是，合成补片可能会造成炎症反应，导致术后食管狭窄，甚至侵蚀等严重并发症。本文报道1例合成补片修补食管裂孔疝术后的狭窄侵蚀病例，及其临床表现和治疗过程。
Gastroesophageal reflux disease (GERD) is a digestive system disease characterized by acid reflux and heartburn. In China, the incidence rate of GERD is increasing year by year, which seriously affects the quality of life of the people. In clinical practice, Western medicine often uses drugs that inhibit gastric acid secretion (proton pump inhibitors), promote gastrointestinal motility, and protect gastric mucosa. However, for some patients, the treatment effect is not ideal, the medication time is long, and the patient's satisfaction is low. Traditional Chinese medicine in China adopts a dialectical thinking mode for the treatment of GERD. After years of exploration, traditional medicine has accumulated rich experience in the treatment of GERD, and has achieved good results. Uighur medicine, as an important component of traditional medicine in China, has been proven to have significant therapeutic effects in the treatment of GERD through years of practice.
Peroral endoscopic cardial constriction (PECC) can effectively treat gastroesophageal reflux disease (GERD), reduce the use rate of antiacid drugs, reduce reflux symptoms of patients, and improve the quality of life of patients. However, the therapeutic principle and long-term therapeutic effect of PECC in treating GERD are not completely clear, and many related studies cannot fully unify some indicators of this technology. In this paper, the latest research progress of this technology is reviewed.
Objective:To investigate the effect of diaphragm biofeedback training on improving symptoms and quality of life in patients with gastroesophageal reflux disease (GERD).Methods:From June 2020 to June 2022, 83 patients with GERD who were admitted to our hospital in laparoscopy and abdominal hernia surgery were selected and randomly divided into control group (n=41) and research group (n=42) according to different nursing interventions; The control group treated with ordinary therapy and routine nursing health guidance intervention, while the research group was given diaphragm biofeedback training and humanistic nursing intervention on the basis of routine drug treatment and health guidance in the control group; Both groups were treated for 8 weeks. GERD symptom score (GERDQ questionnaire), quality of life assessment (SF-36), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Pittsburgh sleep quality index (PSQI) were collected before and after treatment in the two groups, and the effects of the two groups on improving the symptoms and quality of life of GERD patients were compared and analyzed. The curative effect of the two groups were evaluated according to the diagnosis and treatment standards agreed by chinese experts on GERD.Results:Compared with those before treatment, GERD symptom score, SAS score, SDS score and PSQI score were significantly decreased in both groups after treatment (P<0.05), and quality of life (SF-36 score) was significantly increased in both groups (P<0.05). Compare to control group, the improvement of the above indicators in the study group markedly significant (P<0.05); It is suggested that the diaphragm biofeedback training nursing intervention can significantly improve the GERD symptoms and improve the occurrence of depression, anxiety and sleep disorders. Compared with the control group, the apparent and total effective rates of the study group were significantly higher than those of the control group; The inefficiency was significantly lower than that of the control group (P<0.05).Conclusion:Diaphragm biofeedback training and personalized nursing intervention have a significant effect on GERD, which is worthy of further clinical application.
Objective:To explore the effects of lianpuyin combined with esmeprazole and mosapride on neurotransmitters, interleukin-17 (IL-17), serum calcitonin gene-related peptide (CGRP) and interleukin-1 in patients with reflux esophagitis β(IL-1 β)Influence of.Methods:96 patients with reflux esophagitis were treated prospectively from May 2020 to January 2022. They were randomly divided into two groups. 48 patients in the control group were treated with esomeprazole combined with Mosapride, and 48 patients in the observation group were treated with Lianpu Yin combined with esomeprazole and Mosapride. The therapeutic effects of the two groups were compared after 8 weeks of treatment.Results:the improvement of CGRP (1.85±0.51) pg/ml, ne (95.72±9.74) ng/ml and 5-HT (27.81±5.19) ng/ml in the observation group at 8 weeks after treatment was better than that in the control group (P<0.05). The endoscopic grading score at 4 weeks after treatment (1.68±0.33) and 8 weeks after treatment (0.51±0.18) were lower than those in the control group (P<0.05). At the same time, the remission rates of the observation group at 2, 4 and 8 weeks after treatment were 45.83%, 68.75% and 91.67% respectively, which were higher than those in the control group (P<0.05).Conclusion:the treatment of lianpuyin combined with esomeprazole and mosapride in patients with reflux esophagitis can reduce the current inflammatory reaction and improve clinical symptoms.
Objective:To investigate the effects of stress on gastric mucosal inflammation and ovarian function in female mice, and the inhibitory effect of Femoston.Methods:8-week old female SPF Kunming mice were randomly divided into control, stress and Femoston intervention group (6 in each group); Female mice in the stress group and Femoston group were restricted in the self-made restraint apparatus for 2 hours every day for 14 days. The histopathological changes of gastric mucosa and ovary were observed under light microscope by H&E staining. The expression of Nox-4 in gastric mucosa and ovary was observed by immunohistochemistry. Further, the levels of Nox-4, antioxidant enzymes (Mn SOD, GSH Px, Catalase) and cytokines (IL1-β, IL-6, TNF-α) in mice ovarian tissue and blood were detected by real-time quantitative RT-PCR and ELISA.Results:H&E staining showed that neutrophils, lymphocytes infiltration and inflammatory changes in gastric mucosa of stress mice; The score of gastric mucositis in stress group was higher(P<0.01). Nox-4 was highly expressed in the gastric mucosa, and its mRNA expression level was increased (P<0.01). Stress increased the mRNA level of gastric cytokines (IL1-β, IL-6, TNF-α).The ovarian tissue of stress showed obvious changes in follicle microstructure, such as primordial follicle (pr), primary follicle (prm), secondary follicle (sf), inflammation (ii) and follicle structure deformation (fd). Femoston improved the abnormality of this follicle structure. The Nox-4 in ovarian mainly expressed in follicular cells; Its mRNA expression level increased (P<0.001); The content of Nox-4 in the blood of stress mice increased (P<0.001). Femoston can effectively reduce the high expression of Nox-4 in ovarian tissue and blood of stressed mice (P<0.01). Stress mice increased the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in blood; The levels of estradiol (E2) and progesterone (Prog) were decreased (P<0.001). Femoston improved the level of E2 (P<0.01). Stress mice decreased the mRNA level of antioxidant enzymes (Mn SOD, GSH Px, Catalase) in ovarian tissue(P<0.001); Femoston increased the expression levels of antioxidant enzymes(P<0.01). Stress increased in blood and ovarian tissue IL1-β, IL-6, TNF-α mRNA levlels, and Femoston effectively inhibited the high expressions of those cytokines(P<0.01). Pearson correlation analysis showed that there was a positive correlation between the serum level of Nox-4 and sex hormones (FSH, LH, E2, Prog) in the stress group (P<0.01). Serum Nox-4 and cytokines(IL1-β, IL-6, TNF-α) were a positive correlation between concentrations (P<0.01).Conclusion:The high expression of Nox-4 in local tissues and blood is related to the gastric mucositis and abnormal ovarian function induced by stress. Femoston can effectively improve the abnormality of ovarian structure and function, deeper mechanism needs further exploration.
食管裂孔疝（esophageal hiatus hernia, EHH）是由于包绕食管的膈肌发育不良导致食管裂孔扩大，腹腔段食管、胃底甚至全胃及部分腹腔器官疝入纵隔，使正常解剖结构中的抗反流机制丧失，导致胃食管反流，并因胃食管反流引起一系列临床症状的疾病，大多数是一种先天性疾病，临床上以呕吐、呕血为主要表现。EHH诊断需要结合临床表现，上消化道造影检查一般可确诊，新生儿期、婴儿期EHH的临床表现不典型，上消化道造影可能出现假阴性结果，极易误诊漏诊，延误患儿病情。近年来使用高分辨率食管测压（high resolution esophageal pressure measurement，HREM）技术辅助诊断EHH越来越多。HREM能够检测食管的压力，可显示食管下括约肌（lower esophageal sphincter，LES）压力与膈肌脚压力带分离，可以避免消化道造影时误吸造影剂或者胃镜检查时食管充气导致食管扩张缩短，而引起人为的短段裂孔疝引起误诊，因此对EHH诊断的特异性更高。亦有通过腹部施压技术模拟腹压增高的辅助手段来提高EHH的阳性诊断率。现分析西安市儿童医院收治的1例EHH患儿病例资料如下。
Objective:To discuss the effect of using a bundle nursing scheme based on the concept of rapid recovery in obese patients with da Vinci surgical robot-assisted sleeve gastrectomy combined with hiatal hernia repair.Methods:A total of 68 obese patients who underwent robot-assisted sleeve gastrectomy combined with hiatal hernia repair in the hospital from March 2021 to March 2022 were included in the study, and all patients received da Vinci surgical robot-assisted sleeve gastrectomy combined with hiatal hernia repair, and were divided into control group (receiving conventional basic nursing) and observation group (receiving cluster nursing plan measures based on the concept of rapid recovery) by random allocation method, (1) comparing the changes of psychological state before and after nursing in the two groups, (2) compare the activity time, drinking time and eating time of the two groups after surgery, (3) compare the occurrence of postoperative pressure ulcers and hypothermia adverse reactions in the two groups, and (4) compare the pain evaluation results of the two groups from the day after surgery to the day of discharge.Results:There was no significant difference between the relevant data and information between the two groups before nursing, P>0.05, and the data and information related to the overall psychological state score of the post-nursing observation group were significantly more advantageous than those in the control group, and the P<0.05 was statistically significant. The observation group had significantly more advantages than the control group, with a P<0.05 and a statistically significant difference. Compared with the data on the occurrence of postoperative pressure ulcer and hypothermia adverse reactions in the two groups, the incidence rate of relevant data and information in the observation group was reduced compared with that in the control group, and the P<0.05 was statistically significant. Compared with the results of the evaluation of pain degree from the day after surgery to the day of discharge between the two groups, the pain degree of the observation group was significantly lower than that of the control group, P<0.05, and the difference was statistically significant.Conclusion:The clustered nursing work based on the concept of rapid recovery is carried out for obese patients assisted by da Vinci surgical robot sleeve gastrectomy combined with hiatal hernia repair, which has a positive impact on the psychological state of patients, can significantly reduce the occurrence of adverse reactions such as pressure ulcers and hypothermia, reduce patients' pain feelings, and promote patients' recovery as soon as possible.
Objective:To investigate the clinical efficacy of modified peroral endoscopic cardial constriction on gastroesophageal reflux disease (GERD).Methods:Thirty-three patients with GERD who received PECC from January 2021 to January 2023 at Xinchang People's Hospital were selected for this study.The DeMeester score,impedance value, lower esophageal sphincter pressure(LESP) and gastroesophageal reflux disease questionnaire (GERD-Q) scores were performed to assess the clinical efficiency at 3 and 6 month after PECC treatment.Results:GERD-Q score,DeMeester score and impedance value decreased after PECC treatment,while the value of LESP increased.Conclusion:Modified PECC is safe and effective for GERD,which can be used in clinical practice.
Hiatal hernias have a high incidence and can cause gastroesophageal reflux, swallowing abnormalities, as well as extra esophageal symptoms, seriously compromising patient life and quality of life. Laparoscopic hiatal hernia (LHHR) repair restores the function of anti reflux at the lower esophagus and improves the quality of life of patients. However, the management of the perioperative period of LHHR has not attracted much attention from experts in the related fields. Among them, venous thromboembolism (VTE) is one of the common complications during the perioperative period and is the third most common cause of death due to vascular disease in the world. VTE not only has a high perioperative incidence, but is an important cause of perioperative mortality in patients with hiatal hernia. This article will therefore review the risk factors and management strategies for perioperative venous thromboembolism in laparoscopic hiatal hernia repair, with a view to reducing the incidence of VTE after hiatal hernia repair.
Objective:To study the effects of Fuzheng Xiaowei Decoction on gastric mucosal repair and nuclear tran-scription factor 2 (Nrf2)/antioxidant reaction element (ARE) pathway in chronic atrophic gastritis (CAG) rats.Methods:Rats were randomly divided into blank control group and modeling group, and CAG model was established by 1-methyl-3-nitro-1-nitroguanidine (MNNG) combined with ethanol gavage. After modeling, rats were randomly divided into CAG group, FuzhengXiaowei decoction low-dose, medium-dose and high-dose groups and positive control group, with 10 rats/group. The rats in the low, medium and high dose groups of FuzhengXiaowei Decoction were administrated by intragastric administration of 0.74 g/kg, 1.48 g/kg and 2.22 g/kg (measured by crude drug content), respectively, while the rats in the positive control group were administrated by intragastric administration of 0.24 g/kg with vitase for 6w. The changes of body mass in each group before and after intervention were measured. The serum levels of cyclooxygenase (COX-2), inducible nitric oxide synthase (i-NOS), interleukin-6, tumor necrosis factor (TNF-α) and gastric mucosa nitric oxide (NO), nitric oxide synthase (NOS), glutathione peroxidase (GSH-Px) were used by enzyme-linked immunosorbent assay (ELISA) The levels of oxidized lipids (LPO), malondialdehyde (MDA), superoxide dismutase (SOD), hematoxylin-eosin (HE) staining were used to detect the pathological changes of gastric mucosa in rats, and the mRNA levels of Nrf2, ARE and HO-1 in gastric mucosa were determined by real-time quantitative polymerase chain reaction (RTq-PCR). The levels of Nrf2, ARE and HO-1 in gastric mucosa were determined by Western blotting.Results:Compared with blank control group, body weight, GSH-Px and SOD levels of gastric mucosa, Nrf2, ARE and HO-1 mRNA and protein levels of gastric tissue in CAG group were significantly decreased (P<0.05). The levels of NO, NOS, LPO and MDA in gastric mucosa and the levels of COX-2, i-NOS, IL-6 and TNF-α in serum were significantly increased (P<0.05). Compared with CAG group, body weight, GSH-Px and SOD levels of gastric mucosa, Nrf2, ARE and HO-1 mRNA and protein levels of gastric tissue in FuzhengXiaowei Decoction dose groups and positive control group were significantly increased (P<0.05). The levels of NO, NOS, LPO and MDA in gastric mucosa, COX-2, i-NOS, IL-6 and TNF-α in serum of rats were significantly decreased (P<0.05), and the gastric histomathological changes of rats were significantly recovered, and with the increase of the dose of FuzhengXiaowei Decoction, the changes of various indexes were better.Conclusion:FuzhengXiaowei Decoction can significantly inhibit the progression of chronic atrophic gastritis in rats, repair the pathological changes of gastric tissue, inhibit inflammation and oxidative stress damage, and its mechanism may be related to the regulation of Nrf2/ARE pathway.
Objective:Mendelian randomization was used to explore whether there is a causal relationship between gastroesophageal reflux disease (GERD) and chronic cough.Methods:We extracted independent genetic variants strongly associated with chronic cough from two published genome-wide association studies (GWAS) and summary statistics for GERD from a GWAS analysis in the European Molecular Biology Laboratory. The causal relationship between chronic cough and GERD was assessed using inverse variance weighted (IVW) as main estimation.Results:GERD was observed for causal association with increased risk for chronic cough for IVW analysis for applying two GWAS data (P=1.70×10?7 and P=2.42×10?5, respectively). However, there was no association of genetically predicted chronic cough with GERD (all P>0.05). None evidence of significant pleiotropy and heterogeneity was observed.Conclusion:There was a causal relationship between GERD and increased risk of chronic cough.
近期，发表于《Surgical Endoscopy》和《Journal of American College of Surgeons》的关于食管裂孔疝（hiatal hernia, HH）复发的解剖学数据分析以及进而对复发机制探讨的2篇论文引起了我们的关注。该文提出了一个需要我们重视的问题：食管裂孔疝修补术后复发，是由于我们修补技术的失败，还是未能阻止HH的进一步发展？
Objective:The effect of laparoscopic sleeve gastrectomy (LSG) on the prevalence of gastroesophageal reflux disease (GERD) is unclear. Our aim is to analyze the impact of LSG on GERD.Methods:Make the retrieval strategy, search the Wanfang, Zhiwang, PubMed, EMbase, The Cochrane Library and Web of Science databases, screen the literature according to the inclusion criteria and exclusion criteria, extract the relevant data of the included literature, and carry on the methodological quality evaluation and Meta analysis.Results:A total of 11 articles and 1034 patients were included. The results of Meta analysis showed that the difference of new GERD symptoms after LSG operation was statistically significant (OR=0.39,95% CI:0.26~0.60), LSG P<0.0001). The number of new GERD symptoms after operation was significantly higher than that before operation. In addition, there was significant difference in GERD-Q score before and after LSG (MD=-0.59, 95% CI:-1.07~-0.11). The rhombus representing the combined effect was located on the left side from the forest map, indicating that the symptoms of GERD were significantly aggravated after LSG. There was significant difference in DeMeester score in 24-hr pH before and after LSG (MD=-11.82,95% CI:-16.27~-7.37, P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the symptoms of GERD after LSG are significantly more severe than before. There was a significant difference in the average number of acid reflux before and after LSG (MD=-15.71,95% CI:-23.97~-7.44). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the average number of acid reflux after LSG is significantly higher than that before operation. The time of acid reflux detected by 24-hr pH before and after LSG was significantly different (SMD=-1.00,95% CI:-1.38~-0.61 P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the acid reflux time after LSG is significantly longer than that before operation. The difference of daily PPI intake before and after LSG was statistically significant (RR=0.41,95% CI:0.23~0.73). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the daily PPI intake after LSG is significantly higher than that before operation. However, there was no significant difference in the changes of GERD symptoms before and after LSG operation (OR=0.97,95% CI:0.46~2.04), LSG 0.093>0.05). There was no significant change in GERD symptoms before and after), LSG operation.Conclusion:Due to the contradictory results of existing studies, the exact effect of LSG on the prevalence of GERD has not been answered. When choosing the appropriate weight loss technique, surgeons should carefully evaluate the preoperative symptoms of GERD in order to more clearly determine the effect of SG on GERD in patients with weight loss.
Objective:To study the?survey on the quality of life of patients with gastroesophageal reflux disease undergoing peroral endoscopic cardial constriction.Methods:In this study, 59 patients with gastroesophageal reflux disease (GERD) who visited the People's Hospital of Xinchang from February 2019 to April 2021 and received peroral endoscopic cardial constriction (PECC) were included. The reflux diagnostic questionnaire (RDQ), gastrointestinal quality of life index (GIQLI),?satisfaction rate, proton pump inhibitor(PPI) usage and postoperative complications were compared and analyzed before and 1, 2, 3, 6?months after treatment.Results:All of the GERD patients received PECC successively and no severe adverse events or complications occurred. The RDQ score decreased from 15.4 ± 2.3 before treatment to 6.1± 2.8, 4.4±1.4, 4.2±1.2 and 4.0±1.0 after treatment for 1month,2months,3months and 6months, with statistically significant differences (P<0.05). The GIQLI score increased from 73.8±13.6 before treatment to 102.8±12.0, 117.2±10.9, 122.6±7.6, 122.9±7.0 after treatment for 1month,2months,3months and 6months, with statistically significant differences (P<0.05). One month after PECC, 28 patients (47.5%) did not need to take PPI at all; two months after operation, 41 patients (71.9%) did not need to take PPI; 47 patients (92.2%) did not need to take PPI afterr PECC 3 to 6 months. The amount of PPI usage after PECC was significantly reduced and the treatment satisfaction was high.Conclusion:PECC can improve the quality of life of GERD patients and reduce the amount of PPI usage.
